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Search results for "Hospitals"

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Journal Article > Study

Reducing unacceptable missed doses: pharmacy assistant–supported medicine administration.

Baqir W, Jones K, Horsley W, et al. Int J Pharm Pract. 2015;23:327-332.

Omitted or delayed medication doses occur frequently in hospitals. Although the majority of these medication administration errors do not harm patients, some have serious effects and contribute to patient deaths. Recent interventions, such as barcode medication administration systems, may help mitigate this problem, but the evidence to date has been mixed on how electronic systems affect omitted or delayed doses. This study evaluated the strategy of providing the support of pharmacy assistants to nurses during medication administration on an acute care ward at a district hospital in England. The intervention group was compared to both intraward and interward control groups. Over the course of 2 weeks, unacceptable omitted medication doses were observed in 18.5% of patients on the control ward, versus only 1.1% of patients on the wards with pharmacy assistant support. While these findings suggest a possible robust solution to this common problem, major limitations to this study include the brief study period and the lack of an economic analysis to support the feasibility of this approach.

Journal Article > Study

Rapid response systems and collective (in)competence: an exploratory analysis of intraprofessional and interprofessional activation factors.

Kitto S, Marshall SD, McMillan SE, et al. J Interprof Care. 2015;29:340-346.

Clinical staff often fail to call rapid response teams to evaluate deteriorating patients, even when objective criteria for calling the team are met. This qualitative study of physicians and nurses at an Australian hospital found that an impaired culture of safety can result in failure to use the rapid response team when appropriate and can also lead to using the team as a workaround to compensate for poor interdisciplinary communication.

Meeting/Conference > Maryland Meeting/Conference

CUSP Implementation Workshop.

Armstrong Institute for Patient Safety and Quality. July 18, 2017; Constellation Energy Building Conference Center, Baltimore, MD.

The comprehensive unit-based safety program (CUSP) approach emphasizes improving safety culture through a continuous process of reporting and learning from errors, improving teamwork, and engaging staff at all levels in safety efforts. This conference will cover how to utilize CUSP, including understanding and addressing challenges to implementation.

Journal Article > Study

Reducing error in anticoagulant dosing via multidisciplinary team rounding at point of care.

Sharma M, Krishnamurthy M, Snyder R, Mauro J. Clin Pract. 2017;7:953.

Anticoagulants are considered high-risk medications due to their narrow therapeutic window and association with adverse drug events. This study suggests that integration of a clinical pharmacist into the inpatient team may help prevent anticoagulation dosing errors and resultant harm to patients.

Journal Article > Study

Extent of diagnostic agreement among medical referrals.

Van Such M, Lohr R, Beckman T, Naessens JM. J Eval Clin Pract. 2017 Apr 4; [Epub ahead of print].

Diagnostic uncertainty is common and can lead to missed or delayed diagnoses. This retrospective medical record review study examined cases where primary care providers sought diagnostic input from subspecialists. Investigators compared the final diagnosis from the subspecialty visit with the presumed diagnosis at the time of the initial subspecialty referral. They found that the diagnosis differed substantially in about one-fifth of cases following the subspecialty consultation. Costs were higher for cases with substantively different diagnoses compared to cases where subspecialists confirmed or further clarified diagnoses. The authors conclude that subspecialty access is critical to timely and accurate diagnosis. A recent WebM&M commentary discussed how cognition can influence diagnostic decision making.

Journal Article > Study

Organizational perspectives of nurse executives in 15 hospitals on the impact and effectiveness of rapid response teams.

Smith PL, McSweeney J. Jt Comm J Qual Patient Saf. 2017;43:289–298.

According to this survey of nursing leaders, they perceived that rapid response teams improve patient outcomes and safety culture. Evaluations of rapid response were usually informal and often did not capture standardized data. The authors advocate for future research to examine what different types of hospitals perceive as valuable in rapid response teams.

Journal Article > Review

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review.

Lambert V, Matthews A, MacDonell R, Fitzsimons J. BMJ Open. 2017;7:e014497.

This systematic review found that rapid response systems or teams are widely used, but comprehensive evaluation of these systems is lacking. The authors call for a sociotechnical evaluation of this complex intervention in order to truly characterize its impact on safety.

Cases & Commentaries

Correct Treatment Plan for Incorrect Diagnosis: A Pharmacist Intervention

  • Web M&M

Scott D. Nelson, PharmD, MS; March 2017

Although meningitis and neurosyphilis were ruled out for a woman presenting with a headache and blurry vision, blood tests returned indicating latent (inactive) syphilis. Due to a history of penicillin allergy, the patient was sent for testing for penicillin sensitivity, which was negative. The allergist placed orders for neurosyphilis treatment—a far higher penicillin dose than needed to treat latent syphilis, and a treatment regimen that would have required hospitalization. Upon review, the pharmacist saw that neurosyphilis had been ruled out, contacted the allergist, and the treatment plan was corrected.

Journal Article > Review

Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review.

Albutt AK, O'Hara JK, Conner MT, Fletcher SJ, Lawton RJ. Health Expect. 2016 Oct 26; [Epub ahead of print].

This systematic review examined whether patient and family member activation of rapid response teams improved recognition of clinical deterioration. Studies demonstrated that patients and family members did not overwhelm rapid response capacity with frequent activations, but they did activate rapid response to convey concerns beyond clinical deterioration. The authors suggest further study is needed to determine how to best engage patients and families to detect clinical deterioration early.

Journal Article > Commentary

Inpatient notes: reducing diagnostic error—a new horizon of opportunities for hospital medicine.

Singh H, Zwaan L. Ann Intern Med. 2016;165:HO2-HO4.

Hospitalists have a key role in facilitating transitions and communication. This commentary discusses how hospitalists can prevent diagnostic errors and reviews opportunities for improvement, including encouraging patient involvement in their care and face-to-face team communication in difficult-to-diagnose cases.

Journal Article > Study

Opportunities to enhance laboratory professionals' role on the diagnostic team.

Taylor JR, Thompson PJ, Genzen JR, Hickner J, Marques MB. Lab Med. 2017;48:97-103.

Diagnostic error represents a significant source of patient harm. In this study, researchers surveyed physicians to understand how to improve the involvement of laboratory professionals in assisting with diagnostic challenges. They conclude that there may be a greater role for laboratory professionals in the diagnostic process beyond providing test results.

Journal Article > Study

Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management.

Finn A, Bondarenka C, Edwards K, Hartwell R, Letton C, Perez A. J Oncol Pharm Pract. 2016 Aug 29; [Epub ahead of print].

Chemotherapy administration has a well known potential for errors. This pre–post study found that implementation of an electronic health record–facilitated, pharmacist-led, standardized ordering and monitoring program for oral chemotherapy led to better identification of prescribing errors. This research adds to the evidence for the role of pharmacists in making cancer care safer.

Journal Article > Review

Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis.

Renaudin P, Boyer L, Esteve MA, Bertault-Peres P, Auquier P, Honore S. Br J Clin Pharmacol. 2016;82:1660-1673.

Pharmacists play a crucial role in ensuring patient safety in hospitalized patients. However, prior studies have found inconsistent effects of medication reconciliation performed by pharmacists at preventing medication errors. This systematic review determined that pharmacist-performed medication reviews may reduce readmissions and emergency department visits after discharge, but the overall quality of the literature was not robust enough to definitively reach this conclusion.

Journal Article > Commentary

Improving safety for hospitalized patients: much progress but many challenges remain.

  • Classic

Kronick R, Arnold S, Brady J. JAMA. 2016;316:489-490.

Patient safety challenges and successes have emerged since the publication of To Err Is Human. This commentary discusses examples of progress such as the wide-scale use of the Comprehensive Unit-based Safety Program and the decrease of hospital-acquired conditions. The authors suggest that future efforts focus on improving measures of adverse events and diagnostic error research.

Journal Article > Study

ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education—2015.

Pedersen CA, Schneider PJ, Scheckelhoff DJ. Am J Health Syst Pharm. 2016;73:1307-1330.

Pharmacists play a central role in medication safety. The authors present the results of the 2015 American Society of Health-System Pharmacists survey, which specifically looked at medication monitoring and patient education practices. The survey results support the growing role of pharmacists in counseling high-risk patients, discharge medication counseling, therapeutic drug monitoring, and medication order review.

Journal Article > Study

An insurer's care transition program emphasizes medication reconciliation, reduces readmissions and costs.

Polinski JM, Moore JM, Kyrychenko P, et al. Health Aff (Millwood). 2016;35:1222-1229.

This intervention study provided pharmacist support to perform medication reconciliation and care coordination for patients discharged from the hospital. Compared to similar-risk patients who did not receive the intervention, those who had medication reconciliation by pharmacists were less likely to be readmitted to the hospital. These results add to the existing literature supporting the utility of pharmacist-led care transition interventions.

Journal Article > Study

Impact of pharmacist-provided medication therapy management on healthcare quality and utilization in recently discharged elderly patients.

Haag JD, Davis AZ, Hoel RW, et al. Am Health Drug Benefits. 2016;9:259-268.

Postdischarge pharmacist medication counseling has been shown to prevent readmissions. This randomized controlled trial of pharmacist-delivered telephone medication counseling did not show any difference in appropriateness of medication use. The authors noted the high frequency of inappropriate medication use overall.

Journal Article > Review

The impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital: a systematic review.

Gill FJ, Leslie GD, Marshall AP. Worldviews Evid Based Nurs. 2016;13:303-313.

Rapid response teams (RRTs) are a widely implemented safety intervention with a growing body of literature supporting their effectiveness. At some hospitals, families can activate the RRT if they are concerned. This systematic review identified successful implementation strategies for family-activated RRTs, but researchers found no clear evidence that this approach improves patient outcomes.

Journal Article > Study

A program to prevent catheter-associated urinary tract infection in acute care.

  • Classic

Saint S, Greene MT, Krein SL, et al. N Engl J Med. 2016;374:2111-2119.

The landmark Keystone ICU study, which achieved remarkable sustained reductions in central line–associated bloodstream infections in intensive care unit (ICU) patients, stands as one of the most prominent successes of the patient safety field. Although the use of a checklist gathered the most publicity, the study's key insight was that preventing health care–associated infections (HAIs) required extensive attention to improving safety culture by addressing the socioadaptive factors within hospitals that contributed to HAIs. In this new AHRQ funded national study, the Comprehensive Unit-based Safety Program was implemented at 603 hospitals in 32 states, with the goal of preventing catheter-associated urinary tract infections in ICU and ward patients. The effort involved socioadaptive interventions (various approaches shown to improve safety culture) and technical interventions (targeted training to reduce usage of indwelling urinary catheters and providing regular data feedback to participating units). Catheter usage and infection rates significantly decreased in ward patients, although no change was found in ICU patients. This study thus represents one of the few safety interventions that has achieved a sustainable improvement in a clinical outcome. An earlier article described the implementation of the program, which involved collaboration between state and national agencies and academic centers. In a 2008 PSNet interview, the study's lead author discussed his work on preventing HAIs.

Journal Article > Study

Partnered pharmacist charting on admission in the general medical and emergency short-stay unit—a cluster-randomised controlled trial in patients with complex medication regimens.

Tong EY, Roman C, Mitra B, et al. J Clin Pharm Ther. 2016;41:414-418.

Medication discrepancies during hospital admission are common and can lead to preventable harm. This study examined the impact of having a pharmacist review medical charts of patients with complex medication regimens who were admitted to a general medical or emergency short-stay unit. The authors found that partnering medical staff with a pharmacist to review patients' admission medications in the chart significantly decreased inpatient medication errors.

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