Frontline worker perceptions of medication safety in India

Abstract

Background: To explore interprofessionals' perceptions about patient safety, particularly medication safety and associated factors and barriers. Methods: A total of 389 respondents were recruited using convenience sample in the cross sectional survey. Results: Medication safety was perceived as somewhat safe (60%). One-third of respondents witnessed 3-4 or more medication errors (MEs) within the past 1 year. Out of that, one quarter were reportedly, sentinel events. More sentinel events were witnessed in public hospitals and solo practice clinics compared with corporate hospitals and nursing homes (p < 0.02). No difference was observed in the occurrence of sentinel events in accredited and nonaccredited facilities (p = 0.30). Younger respondents witnessed more MEs, whereas accredited hospitals (mostly corporate hospitals) witnessed significantly fewer MEs and graded overall safety as 'better'. However, most MEs go unreported particularly in solo practice clinics (88%) followed by nursing homes (67%), public hospitals (54%), and corporate hospitals (42%). Error identification and subsequent disclosure was inhibited by several system factors: fear of punitive action and lack of reporting systems. General surgical (46%), medical (42%), and paediatric units (36%), were the most error-prone places. Documentation diverted all healthcare workers from direct patient care. Many doctors and pharmacists from nursing homes, solo clinics and public hospitals reported working overtime. Staff shortages and poor training were overwhelming concerns to all healthcare workers and in public hospitals. Solo clinics and nursing homes perceived more barriers; lack of reporting systems, standard protocol, and resources for patient safety and unfamiliarity with prescribed medications was their overwhelming concern. Other factors threatening MEs were a lack of team approach and openness in interdisciplinary communications, illegible medical orders, and medicines prescribed by brand names. Conclusions: Immediate interventions to improve medication safety include enforcement of legible/printed medical orders in generic names, workforce development, developing standard protocols, and a corresponding change in organizational culture. Accreditation can serve as a driver for improving patient safety.

Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review

“…Of the 30 included papers, there were quantitative approaches comprising four randomized controlled trials [6,7,8,9], four prospective cohort studies [10,11,12,13], one retrospective cohort study [14], 12 pre-post interventions [15,16,17,18,19,20,21,22,23,24,25,26], and four cross sectional studies [27,28,29,30]. In relation to qualitative approaches, critical ethnographic studies [31,32,33] and exploratory focus group and interview studies [34,35] were undertaken (Table 1).…”

“…Three studies were ethnographic in nature, which were conducted in medical wards [31,32,33]. The remaining studies comprised focus group [34], interview [35] and cross-sectional survey designs [29,30].…”

Profile of medicines used via oral and gastrointestinal catheter in a Walk-in Service

“…Unfortunately, in the occurrence of adverse events or errors, the punitive approach is present in daily care. However, this approach should be avoided given its ineffectiveness for combating human failures (3)(4) .…”

“…Among the goals advocated by the World Health Organization are the safe preparation and administration of medicines. In recent years, medication errors have been identified as determinants of potential harm to patients (3) . The causes of errors are usually systemic and have multiple origins, namely: disorganized work environment, lack of attention/concentration, communication failure, lack of information about medications and the patient.…”

“…However, if inadequately performed, drug administration by this route may result in catheter obstruction, decreased drug efficacy, increased adverse effects or drug incompatibility with enteral nutrition (EN). These factors cause harm to patients, increase costs for the institution and burden the responsible team's work (3,5,(9)(10) .…”