The medication process in a psychiatric hospital: are errors a potential threat to patient safety?

Soerensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter; Poulsen, Birgitte Klindt; Mainz, Jan

doi:10.2147/rmhp.s47723

Cited by 34 publications

(18 citation statements)

References 28 publications

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“…Moreover, nurses have reported to be lacking in confidence when discussing treatment options with patients, carers and medical colleague (Bressington, Mui, & Wells, 2013). A lack of knowledge about these medicines can lead to errors during the management process as demonstrated by a relatively recent study that observed administration errors accounted for 75% of all medicine-related errors (Soerensen, Lisby, Nielsen, Poulsen, & Mainz, 2013) and can result in patient harm. For example, anecdotal evidence suggests that nurses frequently mistake the side effects of neuroleptic malignant syndrome or akathisia with psychotic agitation.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Antipsychotic medication side effects knowledge amongst registered mental health nurses in England: A national survey

Begum

Mutsatsa

Gul

et al. 2020

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Research findings indicate the percentage of knowledge‐related errors in medicines management is high, accounting for approximately 75% of all errors, with insufficient knowledge levels one of the most significant contributors of medication errors. Patients should be able to trust nurses to engage therapeutically and actively listen to their needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon. However, without knowledge of pharmacology, it is impossible for nurses to be able to provide adequate advice. What the paper adds to the existing knowledge? This study has examined an area that had not yet been systematically examined previously, which draws together previous research findings on mental health nurses' knowledge of adverse events, including side effects and medication errors, related to antipsychotic medication within NHS inpatient settings. What are the implications for practice? A recent study has found that almost three‐quarters (73%) of patients taking antipsychotic medication reported side effects to some degree. This high number of people experiencing antipsychotic medication side effects is likely to compromise care, especially in situations where nurses have inadequate knowledge of side effects and are unable to provide effective advice to patients. The findings from this study allow the mental health nursing profession an opportunity to reflect on the best means to increase knowledge and increase patient safety awareness and benefits for mental health service users. Abstract IntroductionAntipsychotic medications play a significant role in the treatment and recovery of people with several psychiatric disorders. However, research findings indicate mental health nurses are insufficiently knowledgeable about antipsychotic medication side effects. AimTo assess practising mental health nurses' knowledge of antipsychotic medication side effects using a Multiple‐Choice Questionnaire (MCQ) across National Health Service (NHS) Trusts in England. HypothesisKnowledge of antipsychotic medication side effects amongst registered mental health nurses is related to their academic qualification, clinical banding and length of experience. MethodA national survey of registered mental health nurses was carried out using an online questionnaire which was disseminated by Research and Development departments. ResultsA total of 504 questionnaires were returned, 245 of which had full data and further analysed. The mean score for the sample was 14.4 and only 21 participants attained a mark of >80%. Implications for PracticeTwo out of three of our hypotheses (that length of experience and clinical banding are directly related to knowledge of antipsychotic medication side effects) were supported. Our study found many nurses have a suboptimal working knowledge of antipsychotic medication side effects which has the potential to compromise care. Strategies need to be put in place to...

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Section: Backg Rou N Dmentioning

confidence: 99%

Antipsychotic medication side effects knowledge amongst registered mental health nurses in England: A national survey

Begum

Mutsatsa

Gul

et al. 2020

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

show abstract

“… 2 13–15 Published studies of PEs (and/or related ADEs) originate from the UK, 9 16–23 the USA 24–27 and Denmark. 28 In common with reviews of general hospital studies, 2 differences in study methods, settings and definitions preclude the synthesis of PE data from relevant studies to gain an overall measure of their impact. 13 15 29 …”

Section: Introductionmentioning

confidence: 99%

“…A number of PE studies carried out in mental health utilised incident/self-reports 21 23 with others using a retrospective medication chart review (with or without incident reports/case note review/direct observation). 16 17 24 25 28 Prospective identification of PEs in UK psychiatry has most commonly involved pharmacists checking prescription charts over different time periods, 9 18–20 22 yielding error rates of 2.2% 18 and 2.4% 22 of prescription items checked (two studies did not provide a denominator 19 20 ) and 31.3% of whole prescriptions checked. 9 Between 42.1% and 65% of PEs are administered to patients before correction by the pharmacist.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, nature and predictors of prescribing errors in mental health hospitals: a prospective multicentre study

et al. 2014

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ObjectiveTo determine the prevalence, nature and predictors of prescribing errors (PEs) in three mental health hospitals.SettingInpatient units in three National Health Service (NHS) mental health hospitals in the North West of England.ParticipantsTrained clinical pharmacists prospectively recorded the number of PEs in newly written or omitted prescription items screened during their routine work on 10 data collection days. A multidisciplinary panel reviewed PE data using established methods to confirm (1) the presence of a PE, (2) the type of PE and (3) whether errors were clinically relevant and likely to cause harm.Primary outcome measuresFrequency, nature and predictors of PEs.ResultsOf 4427 screened prescription items, 281 were found to have one or more PEs (error rate 6.3% (95% CI 5.6 to 7.1%)). Multivariate analysis revealed that specialty trainees (OR 1.23 (1.01 to 1.51)) and staff grade psychiatrists (OR 1.50 (1.05 to 2.13)) were more likely to make PEs when compared to foundation year (FY) one doctors, and that specialty trainees and consultant psychiatrists were twice as likely to make clinically relevant PEs (OR 2.61 (2.11 to 3.22) and 2.03 (1.66 to 2.50), respectively) compared to FY one staff. Prescription items screened during the prescription chart rewrite (OR 0.52 (0.33 to 0.82)) or at discharge (OR 0.87 (0.79 to 0.97)) were less likely to be associated with PEs than items assessed during inpatient stay, although they were more likely to be associated with clinically relevant PEs (OR 2.27 (1.72 to 2.99) and 4.23 (3.68 to 4.87), respectively). Prescription items screened at hospital admission were five times more likely (OR 5.39 (2.72 to 10.69)) to be associated with clinically relevant errors than those screened during patient stay.ConclusionsPEs may be more common in mental health hospitals than previously reported and important targets to minimise these errors have been identified.

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“…In our study, the rate of dispensing errors was more than 30%, higher than that reported in other studies. [ 36 , 37 ] Omission was the most frequent type of dispensing error. However and importantly, corresponding drugs were mainly analgesics and laxatives which were prescribed but administered only on patient demand.…”

Section: Discussionmentioning

confidence: 99%

An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit

et al. 2015

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AimTo assess the impact of the implementation of a Computerized Physician Order Entry (CPOE) associated with a pharmaceutical checking of medication orders on medication errors in the 3 stages of drug management (i.e. prescription, dispensing and administration) in an orthopaedic surgery unit.MethodsA before-after observational study was conducted in the 66-bed orthopaedic surgery unit of a teaching hospital (700 beds) in Paris France. Direct disguised observation was used to detect errors in prescription, dispensing and administration of drugs, before and after the introduction of computerized prescriptions. Compliance between dispensing and administration on the one hand and the medical prescription on the other hand was studied. The frequencies and types of errors in prescribing, dispensing and administration were investigated.ResultsDuring the pre and post-CPOE period (two days for each period) 111 and 86 patients were observed, respectively, with corresponding 1,593 and 1,388 prescribed drugs. The use of electronic prescribing led to a significant 92% decrease in prescribing errors (479/1593 prescribed drugs (30.1%) vs 33/1388 (2.4%), p < 0.0001) and to a 17.5% significant decrease in administration errors (209/1222 opportunities (17.1%) vs 200/1413 (14.2%), p < 0.05). No significant difference was found in regards to dispensing errors (430/1219 opportunities (35.3%) vs 449/1407 (31.9%), p = 0.07).ConclusionThe use of CPOE and a pharmacist checking medication orders in an orthopaedic surgery unit reduced the incidence of medication errors in the prescribing and administration stages. The study results suggest that CPOE is a convenient system for improving the quality and safety of drug management.

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The medication process in a psychiatric hospital: are errors a potential threat to patient safety?

Cited by 34 publications

References 28 publications

Antipsychotic medication side effects knowledge amongst registered mental health nurses in England: A national survey

Antipsychotic medication side effects knowledge amongst registered mental health nurses in England: A national survey

Prevalence, nature and predictors of prescribing errors in mental health hospitals: a prospective multicentre study

An Observational Study of the Impact of a Computerized Physician Order Entry System on the Rate of Medication Errors in an Orthopaedic Surgery Unit

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