Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008

Roughead, Elizabeth E.; Semple, Susan J.

doi:10.1186/1743-8462-6-18

Cited by 165 publications

(187 citation statements)

References 41 publications

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“…2 Roughead and Lexchin estimated that 2 million Australians experience an ADE annually, of which half are moderate or severe with 138 000 requiring hospitalisation. 3 Further, a recent review by Roughead and Semple 4 concluded that 2-3% of Australian hospital admissions are medication related, representing an estimated 190 000 medication-related hospital admissions per year, with associated costs of A$660 million. Studies by Galbraith 5 and Dartnell et al 6 indicate that unplanned admissions via the Emergency Department (ED) are even more likely to be medication related, with the authors reporting that ADEs account for 6.4% and 5.7% of admissions, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, a 2009 report by the National Prescribing Service concluded that approximately 5.6% of general hospital admissions and 30.4% of hospital admissions in patients 75 years and older in Australia are related to ADEs. 7 Of the Australian studies that have assessed preventability, Roughead and Semple 4 found that approximately 50% of ADE-related admissions (ADE-RAs) were potentially preventable.…”

Section: Introductionmentioning

confidence: 99%

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Hospital admissions caused by adverse drug events: an Australian prospective study

Phillips¹,

Nigro²,

Macolino³

et al. 2014

Aust. Health Review

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Objective. To assess the frequency of adverse drug event (ADE)-related admissions (ADE-RAs) during a prospective medical record review of patients admitted to a metropolitan tertiary referral hospital.Methods. Potential ADE-RA cases were identified by examination of case records of randomly selected patients. Cases were assessed by an expert panel to measure study outcomes, which were the frequency (ADEs and ADE-RAs) as well as type, likelihood of causality, severity, avoidability and detection of ADEs.Results. Of the 370 subjects, 59 (16.0%) had a confirmed ADE-RA, with 15 (4.1%) of these serious and preventable. The 59 ADE-RAs were a result of 72 discreet ADEs. Adverse drug reactions were the most common type of ADE, followed by non-compliance. Of the 72 discreet ADEs, 31.9% were classified as 'probable' or 'highly probable'. Most ADEs (54.2%) were classified as 'definitely avoidable', 34.7% were classified as 'severe' and 21.8% were classified as both 'definitely avoidable' and 'severe'. Half the ADEs were detected after the patient had been admitted and most were detected by medical practitioners. Antineoplastics followed by antidiabetic agents were most frequently implicated.Conclusions. Implementing a systems approach that involves multiple strategies, such as improving tertiary-toprimary care information transfer and promoting medication adherence through education programs, is necessary to tackle the problem of avoidable ADE-RAs and the associated cost burden.What is known about the topic? It is estimated that 2-3% of Australian hospital admissions are due to adverse drug events (ADEs), but recent data are lacking. According to the Australian Statistics on Medicines, over 250 million prescriptions were dispensed in 2007, compared with just under 180 million in 1997. This 40% increase in drug utilisation over the 10 years surpasses the Australian population growth of 14% in the same period. An increase in drug use per person indicates that the rate of ADEs and possible ADE-related admissions (ADE-RAs) is likely to have increased. What does this paper add? This prospective study was conducted at a large Australian metropolitan teaching hospital and we report that 59 of 370 participants (16.0%) presenting to the Emergency Department had a confirmed ADE-RA, with 15 (4.1%) presenting with a serious and preventable ADE-RA. What are the implications for practitioners? The findings of this study support implementing a systems approach involving multiple strategies to tackle the problem of avoidable ADE-RAs and the associated cost burden. This study reveals that half the ADEs were not detected until after the admission process, which reinforces the importance of focusing efforts Journal compilation Ó AHHA 2014

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital admissions caused by adverse drug events: an Australian prospective study

Phillips¹,

Nigro²,

Macolino³

et al. 2014

Aust. Health Review

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“…Penelitian di Australia didapatkan 190.000 pasien di rawat inap berkaitan dengan medication error per tahun dan menghabiskan biaya 660 juta dolar (Roughead and Semple, 2009).…”

Section: Pendahuluanunclassified

Evaluasi Dampak Penerapan Automated Dispensing Machine Terhadap Dispensing Error Di Farmasi Rawat Jalan Instalasi Farmasi Rumah Sakit Bethesda Yogyakarta

2016

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(37,915.33 ± 3,160.12), higher than before implementation (36,812.67 ± 2,890.81), but not significant. The average of dispensing error after implementation (15,67 ± 6,28) was reduced significantly (p<0,05) than before (50.33 ± 34.47). The most frequent type of dispensing error were wrong quantity dispensed, wrong drug dispensed and wrong strength dispensed. The implementation of automated dispensing machine significantly reduce the incidence of dispensing error. Further investigaation needed to know the incidence of dispesning error cause by the machine and manual and factors that influenced. Keywords: automated dispensing machine, dispensing error PENDAHULUANPelayanan kesehatan merupakan sistem kompleks yang ditandai dengan penggunaan teknologi tinggi, pelayanan multidisiplin dengan kebebasan dalam menjalankan profesi. Pelayanan kesehatan tidak dapat dilepaskan terhadap kemungkinan untuk membuat kesalahan atau melakukan pelayanan yang tidak sesuai dengan standar sehingga berpotensi atau bisa menyebabkan kejadian yang tidak diinginkan dan membahayakan pasien. Kegagalan untuk melaksanakan apa yang sudah direncanakan untuk mencapai tujuan yang sudah ditetapkan atau melaksanakan perencanaan yang tidak sesuai dengan tujuan yang akan dicapai (medical error) harus senantiasa diminimalkan dalam setiap upaya pelayanan kesehatan yang bermutu dan aman (Kohn et al., 2000).Di Amerika Serikat dilaporkan 44.000 sampai 98.000 pasien meninggal setiap tahun akibat medical error. Dampak medical error sangat beragam mulai dari yang sangat ringan dan bisa pulih, sampai berat yang dapat menyebabkan kecacatan dan kematian. Medical error juga dapat menyebabkan bertambah parahnya penyakit sehingga lama dan biaya perawatan bertambah (Gyllensten, 2013).

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“…17 Researchers claim that several factors may predispose to medication errors, such as overwork, lack of attention during medication prescribing, dispensing and administering processes, communication failures between teams and between sectors, lack of information about the patient, difficulty in accessing information about medications, as well as environmental and individual factors. 18 Incorporating principles to reduce human error by minimizing memory lapses, promoting access to drug information, and developing internal training standards reduces the likelihood of failures and increases the chance of intercepting them before resulting in harm to the patient. In this sense, strategies such as the standardization of processes, the use of information technology resources, permanent education and, above all, the monitoring of professional practices in all stages of the process involving the medicine must be included.…”

mentioning

confidence: 99%

Análise do aprazamento de enfermagem em uma UTI: foco na segurança do paciente / Analysis of nursing aprazamento in an ICU: focus on patient safety

Ribeiro

Almeida

Henrique

et al. 2018

R. pesq. cuid. fundam. online

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Objetivo: Identificar as não conformidades relacionadas ao aprazamento medicamentoso. Método: Trata-se de um estudo transversal, descritivo, com análise documental e abordagem quantitativa, realizado em uma Unidade de Terapia Intensiva Geral de um hospital universitário do Rio de Janeiro. Resultados: Foram analisadas 362 prescrições. As não conformidades encontradas foram: aprazamento com intervalos não condizentes com a prescrição (80,5%), ausência do carimbo do responsável pelo aprazamento (46%), aprazamento em medicações à critério médico ou suspensas (19%), dentre outros. Conclusão: Ações de enfermagem que poderiam ser realizadas como barreiras frente as não conformidades encontradas seriam: continuação da dupla checagem, elaboração de um guia para o aprazamento; um local privativo para a realização do aprazamento ou utilização de uma sinalização na roupa do aprazador e aprazamento com sistema digital a fim de evitar interações.Descritores: Erros de medicação, Segurança do paciente, Enfermagem de cuidados críticos

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Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008

Cited by 165 publications

References 41 publications

Hospital admissions caused by adverse drug events: an Australian prospective study

Hospital admissions caused by adverse drug events: an Australian prospective study

Evaluasi Dampak Penerapan Automated Dispensing Machine Terhadap Dispensing Error Di Farmasi Rawat Jalan Instalasi Farmasi Rumah Sakit Bethesda Yogyakarta

Análise do aprazamento de enfermagem em uma UTI: foco na segurança do paciente / Analysis of nursing aprazamento in an ICU: focus on patient safety

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