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Search results for "United States of America"

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Journal Article > Review

Interventions to improve oral chemotherapy safety and quality: a systematic review.

Zerillo JA, Goldenberg BA, Kotecha RR, Tewari AK, Jacobson JO, Krzyzanowska MK. JAMA Oncol. 2017 Jun 1; [Epub ahead of print].

This systematic review of quality and safety practices for oral chemotherapy found that telephone calls from nurses identified adverse medication events and supported adherence. Technology-enabled approaches such as text messaging, interactive voice response, and video-observed therapy have not been effective to date.

Book/Report

ISMP Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults.

Horsham, PA: Institute for Safe Medication Practices; May 2017.

Insulin is a widely used medication that can contribute to serious patient harm if used incorrectly. This report provides information about problems associated with insulin use in adults and offers consensus-developed strategies to encourage subcutaneous insulin practices that reduce errors at the prescribing, pharmacy management, administration, and transition phases.

Journal Article > Study

Postoperative opioid prescribing and the pain scores on Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Lee JS, Hu HM, Brummett CM, et al. JAMA. 2017;317:2013-2015.

The opioid crisis is one of the nation's most pressing patient safety problems. Concern has been raised that overprescribing of opioids may be an unintended consequence of efforts to improve patient satisfaction. However, this Michigan study found no relationship between postoperative opioid prescribing and patient satisfaction scores, indicating that efforts to reduce opioid prescribing may not adversely affect patient satisfaction.

Journal Article > Study

Root cause analysis of adverse events in an outpatient anticoagulation management consortium.

Graves CM, Haymart B, Kline-Rogers E, et al. Jt Comm J Qual Patient Saf. 2017;43:299-307.

Anticoagulation confers a high risk of adverse drug events. Examining root cause analyses of anticoagulation–related adverse events, this study found that the majority were not preventable and were due to patient-specific issues. Unlike a prior study, researchers did not include patient perspectives in their analysis, which may have affected their conclusions.

Journal Article > Study

New persistent opioid use after minor and major surgical procedures in US adults.

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Brummett CM, Waljee JF, Goesling J, et al. JAMA Surg. 2017 Apr 12; [Epub ahead of print].

Opioid medication use represents a significant safety problem in the United States. Overprescribing by providers is one factor contributing to the widespread use of opioids. Reducing inappropriate prescribing may help improve patient safety. Using claims data for 36,177 patients, investigators sought to better characterize new and persistent opioid use after surgery, defined as filling an opioid prescription between 90 and 180 days postoperatively. Although there was no major difference in persistent opioid use between those who underwent minor surgical procedures and those who underwent major surgical procedures, results demonstrated that opioid use persisted in greater frequency after surgery among patients with behavioral, pain, and substance use disorders. A recent PSNet perspective discussed patient safety with regard to opioid medications.

Newspaper/Magazine Article

The opioid crisis: can improving diagnosis help solve the problem?

Carr S. ImproveDx. April 2017;4:1-4.

The opioid epidemic has been widely discussed, but little research has examined how misdiagnosis can contribute to the problem. This newsletter article suggests that addressing bias, improving diagnosis, and providing pain management training for primary care providers could augment opioid safety.

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

Automated detection of look-alike/sound-alike medication errors.

Rash-Foanio C, Galanter W, Bryson M, et al. Am J Health Syst Pharm. 2017;74:521-527.

Look-alike and sound-alike medications increase the risk of adverse drug events. This retrospective study found that look-alike and sound-alike medications can be identified in an automated fashion by comparing a medication and its known look-alike and sound-alike medications to diagnostic codes at the point of computerized provider order entry. This is a promising strategy for preventing this type of prescribing error.

Journal Article > Study

Prescription opioid exposures among children and adolescents in the United States: 2000–2015.

Allen JD, Casavant MJ, Spiller HA, Chounthirath T, Hodges NL, Smith GA. Pediatrics. 2017;139:e20163382.

Opioid use remains a high priority safety issue. This retrospective study of data from the National Poison Data System reveals that opioid ingestions by children increased from 2000–2009 and then began to decline. Hydrocodone was the most common opioid implicated in these cases, and adolescents were most likely to experience severe harm.

Journal Article > Study

Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015.

McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Pediatrics. 2017;139:e2016-e2387.

Opioid use is a patient safety epidemic. This survey of high school seniors in the United States found that prescription opioid use usually precedes nonmedical opioid use, suggesting that improving prescribing practices in accordance with the recent Centers for Disease Control and Prevention guideline is important to address medical and nonmedical opioid use.

Tools/Toolkit > Measurement Tool/Indicator

2017 ISMP Medication Safety Self Assessment® for Antithrombotic Therapy in Hospitals.

Horsham, PA: Institute for Safe Medication Practices; 2017.

This tool provides institutions with the capacity to assess use of antithrombotic agents, submit data to the Institution for Safe Medication Practices for self-assessment scores, compare practices with other hospitals, and allow the development of an ongoing progress report.

Journal Article > Government Resource

Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015.

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Shah A, Hayes CJ, Martin BC. MMWR Morb Mortal Wkly Rep. 2017;66:265-269.

Opioid use has become a growing patient safety concern. Recent studies have documented wide variation in opioid prescribing for acute pain and a significant rate of chronic opioid use after patients receive a first prescription for an acute indication. This retrospective medical record review study identified risk factors for remaining on an opioid medication for more than 1 year following their initial prescription. Older, female, and publicly or self-insured patients were more likely to remain on an opioid compared with younger, male, and privately insured patients. Patients started on higher doses (cumulative dose ≥ 700 mg morphine equivalent), provided prescriptions with longer duration (more than 10 days), or given 3 or more prescriptions for opioids were most likely to continue to use opioid medications 1 year later. The authors recommend prescribing fewer than 7 days of opioids for acute pain and adhering to the Centers for Disease Control and Prevention guideline for opioid use to improve prescribing practices.

Journal Article > Study

Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis.

Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. BMJ. 2017;356:j760.

Concurrent use of opioids and benzodiazepines increases risk for adverse drug events. This retrospective analysis of medical claims found that the risk of emergency department visit was greater for patients with concurrent use of these two medication classes compared to patients on opioids alone. This finding supports the recommendation to avoid coprescribing these two medication classes.

Journal Article > Commentary

Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs.

Gellad WF, Good CB, Shulkin DJ. JAMA Intern Med. 2017;177:611-612.

Opioid medications are a known safety hazard, and overdoses of opioid medications are considered an epidemic in the United States. This commentary discusses US Veterans Affairs health system initiatives that focus on education, prescription monitoring, pain management, and use of guidelines to reduce risks associated with opioids.

Journal Article > Study

Significant and sustained reduction in chemotherapy errors through improvement science.

Weiss BD, Scott M, Demmel K, Kotagal UR, Perentesis JP, Walsh KE. J Oncol Pract. 2017;13:e329-e336.

Prescribing and administering chemotherapy involves complex processes that are vulnerable to error. This study discussed how improvement efforts, including standardization and minimizing interruptions, led to a decrease in the rate of chemotherapy errors reaching patients at a large urban academic pediatric medical center.

Journal Article > Study

Opioid-prescribing patterns of emergency physicians and risk of long-term use.

Barnett ML, Olenski AR, Jena AB. N Engl J Med. 2017;376:663-673.

The opioid epidemic is currently one of the most pressing patient safety challenges, as discussed in a recent Annual Perspective. High-risk prescribing practices by clinicians is one contributing factor in the surge in opioid use among patients. Prior research has shown that patients often receive opioids following low-risk procedures, and they frequently receive opioid prescriptions even after overdosing on these medications. This cohort study found wide variations in opioid prescribing practices among emergency departments, with some physicians prescribing opioids almost three times as often even after controlling for patient characteristics. Notably, patients who received opioids from a high-intensity prescriber were significantly more likely to continue using opioids 12 months later—indicating a possible connection between physician prescribing practices and subsequent opioid addiction. The study confirms that reducing variation in physician prescribing practices should be one component of an overall strategy to address opioid overuse.

Journal Article > Commentary

Opioids for pain management in older adults: strategies for safe prescribing.

Davies PS. Nurse Pract. 2017;42:20-26.

Use of opioids for pain management in older adults can contribute to various problems, including fall-related injury and delirium. This commentary discusses the role of nurse practitioners as prescribers of opioids and offers practice recommendations to reduce risks.

Journal Article > Study

Development and applications of the Veterans Health Administration's Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide.

Oliva EM, Bowe T, Tavakoli S, et al. Psychol Serv. 2017;14:34-49.

Opioid-related harm is an urgent patient safety priority. Identifying patients at higher risk of harm is a critical aspect of opioid safety. This quality improvement team developed a predictive model, based on electronic health record data, to identify high-risk opioid users in order to provide targeted monitoring and intervention via a clinical decision support tool. The model included known risk factors for opioid-related harm, such as type of medication, dose, and coprescribed sedating medications as well as medical and mental health conditions. Investigators developed and validated the model using data from 2010 and tested its ability to predict overdose or suicide attempt in 2011. The model successfully and prospectively identified patients at risk for suicide attempt or overdose. They then used the electronic health record to provide physicians with an overdose or suicide risk estimate and a checklist of risk mitigation strategies at the point of care. The authors suggest that further study of the implementation of this risk mitigation strategy in primary care is needed.

Journal Article > Review

The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.

Ratanawongsa N, Chan LLS, Fouts MM, Murphy EJ. J Diabetes Res. 2017;2017:8983237.

Diabetes medications are known to be high risk for adverse drug events. This case study reviews several patient safety measures for electronic prescribing for diabetes in outpatient care. Researchers describe an adverse drug event involving electronic prescribing of insulin and detail how the incident could have been prevented. Electronic prescribing is not currently standardized and may require using a trade name for medications, which may lead to prescribing errors. Adoption of the medication naming conventions put forth by the National Library of Medicine's RxNorm would prevent this vulnerability. Similarly, standardizing electronic prescribing orders for high-risk medications like insulin may reduce the risk of erroneously choosing a long-acting instead of short-acting insulin formulation, which can have life-threatening consequences. The authors advocate for using Universal Medication Schedule instructions and providing language-concordant labels to patients to support safe medication self-administration. They suggest that real-time, bidirectional communication between prescribers and pharmacists may improve safe prescribing. The authors conclude that recommended safety practices are not uniformly implemented in clinical practice and advocate for implementation research to ensure medication safety for outpatients with diabetes.

Journal Article > Study

Medication errors associated with transition from insulin pens to insulin vials.

Trimble AN, Bishop B, Rampe N. Am J Health Syst Pharm. 2017;74:70-75.

Insulin is a high-risk medication. This pre–post study examined the risk for insulin dosing errors after a transition from insulin pens to vials. Three major insulin administration errors occurred, which led to training and process changes in order to mitigate the risk of harm.

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