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Search results for "Health Care Executives and Administrators"

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Journal Article > Study

Analysis of prescribers' notes in electronic prescriptions in ambulatory practice.

  • Classic

Dhavle AA, Yang Y, Rupp MT, Singh H, Ward-Charlerie S, Ruiz J. JAMA Intern Med. 2016;176:463-470.

Many ambulatory practices have recently introduced electronic prescribing, which has the potential to improve medication safety. In this large cross-sectional study, researchers analyzed more than 26,000 electronic prescriptions that included free-text notes sent to community pharmacies. Two-thirds of free-text notes contained inappropriate content, despite the availability of a standard data field. Nearly 1 in 5 of these notes included conflicting administration instructions from the designated structured field, creating an important source of potential medication errors. In addition, approximately 5% of notes contained irrelevant information, which may distract or confuse pharmacy staff. The authors outline recommended solutions based on the information most commonly included in prescription free-text notes.

Journal Article > Study

Psychometric properties of the AHRQ Community Pharmacy Survey on Patient Safety Culture: a factor analysis.

Aboneh EA, Look KA, Stone JA, Lester CA, Chui MA. BMJ Qual Saf. 2016;25:355-363.

The Agency for Healthcare Research and Quality has developed safety culture surveys for multiple health care settings. Researchers distributed the survey to community pharmacies and found its validity to be inadequate for use in this environment. This suggests that instruments used in other settings will require significant adaptation to accurately measure patient safety in pharmacies.

Journal Article > Study

Exploring safety systems for dispensing in community pharmacies: focusing on how staff relate to organizational components.

Harvey J, Avery AJ, Ashcroft D, Boyd M, Phipps DL, Barber N. Res Social Adm Pharm. 2015;11:216-227.

This qualitative study characterized safety hazards in medication dispensing in community pharmacies. The authors conclude that the major sources of risk pertained to interruptions and distractions, which were often exacerbated by production pressures.

Journal Article > Study

How useful are medication patient information leaflets to older adults? A content, readability and layout analysis.

Liu F, Abdul-Hussain S, Mahboob S, Rai V, Kostrzewski A. Int J Clin Pharm. 2014;36:827-834.

Elderly patients are particularly vulnerable to adverse drug events. This analysis found that the majority of medication information leaflets were difficult for older patients to read and interpret. Similar problems have been found with medication labels.

Journal Article > Study

The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study.

Franklin BD, Reynolds M, Sadler S, et al. BMJ Qual Saf. 2014;23:629-638.

This study of medication dispensing errors at community pharmacies found that electronic transmission of prescriptions resulted in increased omission of the medication indication, but that other error types did not change. These findings suggest that electronic prescribing alone is not sufficient to address outpatient dispensing errors.

Cases & Commentaries

Clostridium Difficile Relapse Secondary to Medication Access Issue

  • Web M&M

Paul C. Walker, PharmD, and Jerod Nagel, PharmD; April 2014

Following a hospitalization for Clostridium Difficile–associated diarrhea, a woman with HIV/AIDS and B-cell lymphoma was discharged with a prescription for a 14-day course of oral vancomycin solution. At her regular retail pharmacy, she was unable to obtain the medicine, and while awaiting coverage approval, she received no treatment. Her symptoms soon returned, prompting an emergency department visit where she was diagnosed with toxic megacolon.

Journal Article > Study

E-prescribing errors in community pharmacies: exploring consequences and contributing factors.

Odukoya OK, Stone JA, Chui MA. Int J Med Inform. 2014;83:427-437.

This direct observation study found that various medication errors related to electronic prescribing occur in community pharmacies. Contributing factors included poor inter-operability between pharmacy and clinic systems, inadequate technology usability, and data entry errors. This finding underscores the growing safety concerns associated with medication prescribing in ambulatory care.

Journal Article > Study

Uptake of quality-related event standards of practice by community pharmacies.

Boyle TA, Bishop AC, Overmars C, et al. J Pharm Pract. 2015;28:442-449.

This analysis of community pharmacy practices found that while most have reporting of medication errors and near misses in place, few establish improvement plans or apply systems approaches to address errors. This finding underscores the need to learn from events and implement changes to resolve safety issues.

Journal Article > Study

The relationships among work stress, strain and self-reported errors in UK community pharmacy.

Johnson SJ, O'Connor EM, Jacobs S, Hassell K, Ashcroft DM. Res Social Adm Pharm. 2014;10:885-895.

This internet-based survey of pharmacists in the United Kingdom revealed an association between self-reported medication dispensing errors and higher perceived workload, similar to prior nursing studies. These findings contrast with earlier research that showed no relationship between physician working conditions and errors.

Journal Article > Study

Exploring information chaos in community pharmacy handoffs.

Chui MA, Stone JA. Res Social Adm Pharm. 2014;10:195-203.

This qualitative study used interviews with community pharmacists to characterize the types of latent errors that can contribute to problems with handoffs in care. Since the handoff process was not standardized, pharmacists reported encountering both information overload and a lack of accurate information when giving and receiving handoffs.

Journal Article > Study

From physician intent to the pharmacy label: prevalence and description of discrepancies from a cross-sectional evaluation of electronic prescriptions.

Cochran GL, Klepser DG, Morien M, Lomelin D, Schainost R, Lander L. BMJ Qual Saf. 2014;23:223-230.

One major safety advantage of computerized provider order entry (CPOE) systems lies in their ability to prevent adverse drug events due to prescribing errors. In the outpatient setting, use of electronic prescriptions is growing thanks to studies demonstrating that e-prescribing reduces medication errors. However, as with CPOE in general, increasing use of e-prescribing is leading to greater recognition of new types of errors associated with this new technology. This study analyzed the frequency of unintended discrepancies in e-prescriptions from three primary care clinics by comparing the prescription information in the prescribing physician's note with the order entered into the e-prescribing system and the medication ultimately dispensed by the pharmacy. The investigators found that errors occurred at each stage of the process, with a small but significant rate of discrepancies between both physician notes and e-prescriptions and between e-prescriptions and the medication dispensed. These errors often occurred when providers entered free-text instructions into the e-prescribing system, as found in prior research. The potential safety benefits and hazards of e-prescribing are discussed in detail in an AHRQ WebM&M commentary.

Journal Article > Study

Classification of medication incidents associated with information technology.

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Cheung KC, van der Veen W, Bouvy ML, Wensing M, van den Bemt PM, de Smet PA. J Am Med Inform Assoc. 2014;21:e63-e70.

Numerous studies have identified unintended consequences associated with health information technology (IT) and computerized provider order entry, but most of these focused exclusively on the hospital setting. This study, which analyzed data from a national database of medication errors in the Netherlands, extends prior studies by examining medication errors related to IT in community pharmacies as well as hospitals. Overall, nearly one in six medication errors was attributable to problems with IT. Human factors engineering issues, such as poorly designed screens and displays, were at the root of a large proportion of these errors. Dr. Donald Norman, a founder of the human factors engineering field, was interviewed by AHRQ WebM&M in 2009.

Journal Article > Study

e-Prescribing: characterisation of patient safety hazards in community pharmacies using a sociotechnical systems approach.

Odukoya OK, Chui MA. BMJ Qual Saf. 2013;22:816-825.

Electronic prescribing is being increasingly utilized as a patient safety strategy in ambulatory care. This qualitative study used field observations and interviews to develop a taxonomy of potential safety hazards when using e-prescribing in community pharmacies.

Journal Article > Study

Usability of a computerised drug monitoring programme to detect adverse drug events and non-compliance in outpatient ambulatory care.

Auger C, Forster AJ, Oake N, Tamblyn R. BMJ Qual Saf. 2013;22:306-316.

Medication errors are one of the most common types of preventable adverse events in ambulatory care, but detecting them is challenging because, unlike hospitalized patients, ambulatory patients are not regularly monitored between visits. Telephone interactive voice response systems (IVRS), which place automated phone calls to patients, have been investigated as a means of detecting adverse events after discharge. This study reports on the feasibility of using IVRS to detect adverse drug events after patients received a new prescription from their primary care physician. The authors identified several limitations: the system only reached 70% of patients despite multiple events, and elderly patients in particular had more technical difficulty with the calls and were less likely to complete them successfully. Further refinement is needed before automated mechanisms can be used to reliably detect outpatient safety problems.

Book/Report

Root Cause Analysis Workbook for Community/Ambulatory Pharmacy.

Horsham, PA: Institute for Safe Medication Practices; 2013.

Root cause analysis offers a structured way to detect and address system weaknesses. This workbook illustrates how root cause analysis can be applied to community pharmacy services to identify problems and design an action plan to implement improvement strategies.

Journal Article > Study

Pharmacy dispensing of electronically discontinued medications.

Allen AS, Sequist TD. Ann Intern Med. 2012;157:700-705.

Electronic prescribing systems have been shown to prevent medication errors in the outpatient setting. However, such systems do not routinely notify pharmacies if a clinician has decided to stop prescribing a medication, creating the potential for harm. Conducted in 15 primary care practices that use a commercial electronic medical record system, this study found that 1.5% of prescriptions discontinued by physicians were subsequently dispensed at least once by pharmacies. Since these medications included high-risk therapies such as antidiabetic and antiplatelet agents, some patients may have experienced preventable harm as a result. This study identifies a previously undocumented type of error in ambulatory care and describes the need to harness technology to facilitate bidirectional communication between providers.

Newspaper/Magazine Article

Prescription drug time guarantees and their impact on patient safety in community pharmacies.

ISMP Medication Safety Alert! Acute Care Edition. September 6, 2012;17:1-4.

This newsletter article discusses results from a survey of community pharmacists on how time guarantees affect their practice.

Journal Article > Study

Differences in medication errors between central and remote site telepharmacies.

Scott DM, Friesner DL, Rathke AM, Peterson CD, Anderson HC. J Am Pharm Assoc. 2012;52:e97-e104.

Medication error rates at community pharmacies (with pharmacists on-site) were similar to rates at remote telepharmacies (which are staffed by pharmacy technicians with remote pharmacist oversight). However, remote telepharmacies reported more near misses.

Journal Article > Study

Risk models to improve safety of dispensing high-alert medications in community pharmacies.

Cohen MR, Smetzer JL, Westphal JE, Comden SC, Horn DM. J Am Pharm Assoc. 2012;52:584-602.

Sociotechnical probabilistic risk assessment—a prospective method of identifying potential patient safety hazards—was used to assess the risk for medication errors in community pharmacies.

Journal Article > Study

Quality-related event learning in community pharmacies: manual versus computerized reporting processes.

Boyle TA, Scobie AC, MacKinnon NJ, Mahaffey T. J Am Pharm Assoc. 2012;52:498-506.

Pharmacists in Canadian community pharmacies had a more positive opinion of a computerized error reporting process compared with a traditional paper-based process.

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