Medication Discrepancies in Resident Sign-Outs and Their Potential to Harm

Arora, Vineet M.; Kao, Julia; Lovinger, David M.; Seiden, Samuel C.; Meltzer, David O.

doi:10.1007/s11606-007-0415-x

Cited by 77 publications

(58 citation statements)

References 15 publications

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“…This parallel record implies that electronic notes are not meeting all their documentation needs, whether due to content, structure or an inherent property of computerized documentation systems, such as their reduced portability. Maintaining two records, however, would seem to add work, reduce efficiency and introduce potential for error 21 .…”

Section: Discussionmentioning

confidence: 99%

Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing

et al. 2008

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“…An unintended consequence of this change in practice was an increase in the number of patient care hand-offs 2 , a vulnerable gap in patient care that is often variable and error prone [3][4][5][6][7][8][9][10] . The 2008…”

Section: Aimmentioning

confidence: 99%

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

et al. 2009

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AIM:The Observed Simulated Hand-off Experience (OSHE) was created to evaluate medical students' sign-out skills using a real-time assessment tool, the Hand-off CEX.SETTING: Thirty-two 4th year medical students participated as part of an elective course.PROGRAM DESCRIPTION: One week following an interactive workshop where students learned effective hand-off strategies, students participated in an experience in which they performed a hand-off of a mock patient using simulated history and physical examination data and a brief video. PROGRAM EVALUATION:Internal medicine residents served as standardized hand-off receivers and were trained on expectations. Students were provided feedback using a newly developed Hand-off CEX, based on the "Mini-CEX," which rates overall hand-off performance and its components on a 9-point Likert-type scale. Outcomes included performance ratings and pre-and poststudent self-assessments of hand-off preparedness. Data were analyzed using Wilcoxon signed-rank tests and descriptive statistics. Resident receivers rated overall student performance with a mean score of 6.75 (range 4-9, maximum 9). Statistically significant improvement was observed in self-perceived preparedness for performing an effective hand-off (67% post-vs. 27% prereporting 'well-prepared,' p<0.009).DISCUSSION: This brief, standardized hand-off training exercise improved students' confidence and was rated highly by trained observers. Future work focuses on formal validation of the Hand-off CEX instrument. 129 SETTINGThe OSHE was a module in a month-long skills-based "Transitions to Internship" elective course offered to graduating students in April of their final year of medical school. Thirty-four students who had matched into nine different specialties participated in the course. This elective focuses specifically on "orphan" topics not addressed elsewhere in the curriculum. Topics include procedural skills, preparedness for life as a resident, advanced communication skills (e.g., obtaining informed consent and disclosing medical error) and personal life preparedness (e.g., debt management and maintaining work/life balance). PROGRAM DESCRIPTIONStudents participated in a 90-min interactive workshop on communication skills necessary to perform effective handoffs (see online Appendix A). This module, delivered by one of the authors (VA), discussed communication theory as it relates to effective hand-off communication. Key points communicated during this workshop included: the importance of face-to-face communication, encouraging questions from the hand-off receiver, providing detailed "to-do" lists with rationale and anticipatory guidance. The instructor included case-based examples on the importance of effective hand-offs both in medicine and other industries 20 .The components of a written hand-off were discussed during the 90-min hand-off training, and students were given a representative example of a high-quality written sign-out 21 .Finally, students were provided with electronic access to the workshop materials and a...

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“…Often, these errors result from failure to keep the sign-out updated. 4 Although the growing adoption of electronic health records can streamline documentation through linking data to sign-out applications, cut and paste problems and information overload may still occur. 5 Ensuring proper creation and maintenance of the written sign-out is critical in today's environment.…”

Section: What Is Knownmentioning

confidence: 99%

Improving Written Sign-Outs Through Education and Structured Audit: The UPDATED Approach

DeKosky¹,

Gangopadhyaya²,

Chan³

et al. 2013

Journal of Graduate Medical Education

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The Accreditation Council for Graduate Medical Education Common Program Requirements mandate that all residency programs need to monitor and ensure resident competency in patient handoffs.1 Changes in resident duty hours have increased the volume and complexity of handoffs and have increased the use of ''bridge'' or ''float'' residents who may not have prior knowledge of the patients. Ensuring proper creation and maintenance of the written sign-out is critical in this environment. Existing curricula to teach sign-out communication to residents have focused almost exclusively on verbal handoffs.2 Tools to facilitate teaching, monitoring, and evaluation of written sign-outs are especially lacking. This becomes even more important given the focus on educational milestones related to written communication, such as providing ''legible, accurate, complete, and timely written communication that is congruent with medical standards. '' 3 What Is KnownStudies suggest that written sign-outs are often plagued by medication errors, including omissions and erroneous information. Often, these errors result from failure to keep the sign-out updated. 4 Although the growing adoption of electronic health records can streamline documentation through linking data to sign-out applications, cut and paste problems and information overload may still occur. 5Ensuring proper creation and maintenance of the written sign-out is critical in today's environment.Structured templates for documenting handoff information are recommended by professional organizations. 6A recent, appreciative-inquiry study 7 in a large internal medicine training program found that handoffs varied widely in the absence of an educational curriculum and that a consistent methodology for sign-out organization is key.One promising technique for teaching written sign-outs is the use of practice audits, which can promote reflection on past performance and facilitate transfer of knowledge into actual clinical practice. 8The UPDATED ApproachThe UPDATED educational approach to teaching written sign-outs emphasizes the importance of the following attributes of sign-outs:Updated administrative data

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Medication Discrepancies in Resident Sign-Outs and Their Potential to Harm

Abstract: Written sign-outs contain potentially harmful medication discrepancies. Whereas linking sign-outs to electronic medical records can address this problem, current efforts should also emphasize the importance of vigilant updating in the many hospitals without this technology.

Cited by 77 publications

References 15 publications

Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing

Physicians’ Attitudes Towards Copy and Pasting in Electronic Note Writing

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

Improving Written Sign-Outs Through Education and Structured Audit: The UPDATED Approach

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