OBJECTIVE: We sought to determine whether patients or their families could identify adverse events in the emergency department (ED), to characterize patient reports of errors and to compare patient reports to events recorded by health care providers. METHODS: This was a prospective cohort study in a quaternary care inner city teaching hospital with approximately 40,000 annual visits. ED patients were recruited for participation in a standardized interview within 24 hours of ED discharge and a follow-up interview 3-7 days after discharge. Responses regarding events were tabulated and compared with physician and nurse notations in the medical record and hospital event reporting system. RESULTS: Of 292 eligible patients, 201 (69%) were interviewed within 24 hours of ED discharge, and 143 (71% of interviewees) underwent a follow-up interview 3-7 days after discharge. Interviewees did not differ from the base ED population in terms of age, sex or language. Analysis of patient interviews identified 10 adverse events (5% incident rate; 95% confidence interval [CI] 2.41%-8.96%), 8 near misses (4% incident rate; 95% CI 1.73%-7.69%) and no medical errors. Of the 10 adverse events, 6 (60%) were characterized as preventable (2 raters; kappa=0.78, standard error [SE] 0.20; 95% CI 0.39-1.00; p=0.01). Adverse events were primarily related to delayed or inadequate analgesia. Only 4 out of 8 (50%) near misses were intercepted by hospital personnel. The secondary interview elicited 2 out of 10 adverse events and 3 out of 8 near misses that had not been identified in the primary interview. No designation (0 out of 10) of an adverse event was recorded in the ED medical record or in the confidential hospital event reporting system. CONCLUSION: ED patients can identify adverse events affecting their care. Moreover, many of these events are not recorded in the medical record. Engaging patients and their family members in identification of errors may enhance patient safety.

BACKGROUND: Computerized decision support systems (DSS) have mainly focused on improving clinicians' diagnostic accuracy in unusual and challenging cases. However, since diagnostic omission errors may predominantly result from incomplete workup in routine clinical practice, the provision of appropriate patient- and context-specific reminders may result in greater impact on patient safety. In this experimental study, a mix of easy and difficult simulated cases were used to assess the impact of a novel diagnostic reminder system (ISABEL) on the quality of clinical decisions made by various grades of clinicians during acute assessment. METHODS: Subjects of different grades (consultants, registrars, senior house officers and medical students), assessed a balanced set of 24 simulated cases on a trial website. Subjects recorded their clinical decisions for the cases (differential diagnosis, test-ordering and treatment), before and after system consultation. A panel of two pediatric consultants independently provided gold standard responses for each case, against which subjects' quality of decisions was measured. The primary outcome measure was change in the count of diagnostic errors of omission (DEO). A more sensitive assessment of the system's impact was achieved using specific quality scores; additional consultation time resulting from DSS use was also calculated. RESULTS: 76 subjects (18 consultants, 24 registrars, 19 senior house officers and 15 students) completed a total of 751 case episodes. The mean count of DEO fell from 5.5 to 5.0 across all subjects (repeated measures ANOVA, p < 0.001); no significant interaction was seen with subject grade. Mean diagnostic quality score increased after system consultation (0.044; 95% confidence interval 0.032, 0.054). ISABEL reminded subjects to consider at least one clinically important diagnosis in 1 in 8 case episodes, and prompted them to order an important test in 1 in 10 case episodes. Median extra time taken for DSS consultation was 1 min (IQR: 30 sec to 2 min). CONCLUSION: The provision of patient- and context-specific reminders has the potential to reduce diagnostic omissions across all subject grades for a range of cases. This study suggests a promising role for the use of future reminder-based DSS in the reduction of diagnostic error.

Estudios recientes avalan la conciliación de la medicación (CM) como paso integral en el proceso del cuidado y como iniciativa importante para la seguridad del paciente. A pesar de ello, estos resultados han sido insuficientemente evaluados. OBJETIVO: determinar si el procedimiento de conciliación es eficaz para la prevención de errores de medicación y/o para mejorar el resultado de la asistencia sanitaria. METODOLOGÍA: se hicieron búsquedas en diversas bases de datos electrónicas (MEDLINE, EMBASE, Scielo, Cochrane) y bases de literatura gris. Fueron seleccionados ensayos clínicos controlados y aleatorizados (ECAs) y en ausencia de estos, otros diseños de investigación (EC no aleatorizados o estudios cuasi-experimentales). Los participantes fueron sujetos de todas las edades. Se incluyeron los siguientes resultados: rehospitalizaciones, visitas a urgencias, reacciones adversas a los fármacos y mortalidad. Dos revisores extrajeron los datos y evaluaron la calidad de los estudios de forma independiente utilizando la escala de Jadad. RESULTADOS: se localizaron 163 artículos y se incluyeron cuatro para la realización de metanálisis. El total de pacientes fue 1.259. La CM tuvo efectos significativos para la reducción de las visitas a urgencias: (odds ratio 0,66; IC del 95%: 0,48-0,90) y las rehospitalizaciones: (odds ratio 0,87; IC del 95%: 0,63-1,19). CONCLUSIONES: la CM es eficaz en la reducción de eventos adversos producidos por errores de medicación y en la reducción de las visitas a urgencias y las hospitalizaciones.

BACKGROUND: Medication errors have been identified as a problem in health care that results in adverse drug events. It has been identified as a failure of an intended plan of action or the initiation of a wrong plan of action. Medication errors are pervasive in community dwelling older adults. Strategies that facilitate the prevention of medication errors warrant consideration. Medication reconciliation has been identified as one such a strategy. OBJECTIVES: The objective of this systematic review was to identify, appraise and synthesize the best available evidence to determine the effectiveness of medication reconciliation strategies on medication errors among community dwelling older adults. INCLUSION CRITERIA: TYPES OF PARTICIPANTS: This review included older adults of all races and ethnicities (65 years of age and older) living in the community. Older adults with dementia or who were dependent on family or other individuals for care were not included. TYPES OF INTERVENTION: This review considered studies that evaluated the effects of medication reconciliation strategies on medication errors in community dwelling older adults. TYPES OF STUDIES: This review considered randomized controlled trials, non-randomized controlled trials and quasi-experimental studies. In the absence of the above, other study designs including case control, cross-sectional cohort, and before and after studies were considered. TYPES OF OUTCOMES: This review considered the primary outcome measure of the number of medication errors. Medication errors may include but are not limited to: prescribing, labeling, dispensing, medication administration and medication reconstitution. SEARCH STRATEGY: This search examined published and unpublished studies from the inception of databases to the present that were in English. Databases included: MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Academic Search Premier, PsycINFO, Healthsource Nursing/Academic edition, and PubMed. Gray literature included Science.gov, scricus.com, Robert Wood Johnson Institute, and Dissertations Abstract International. Searches were completed in November 2012. METHODOLOGICAL QUALITY: Two independent reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instruments from the Joanna Briggs Institute. Disagreements between the reviewers were resolved with a third reviewer. DATA COLLECTION: Data were extracted using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS: Statistical pooling was not possible due to heterogeneity of the studies; therefore findings were presented as a narrative. RESULTS: This review yielded two level one randomized controlled trials and one level three prospective randomized comparative study. Studies presented evidence as to the potential positive outcomes of a pharmacist-led medication reconciliation on medication errors for community dwelling older adults. The way in which the pharmacist conducted the medication reconciliation varied across studies. CONCLUSIONS: Medication reconciliation is complex and may be implemented in a variety of ways. For older adults residing in community settings, pharmacist-led medication reconciliation may possibly play a role in the reduction of medication errors.

Recent studies support medication reconciliation (MR) as an imegral step in the process ofcare andas an importam initiativefor the patient's safety. Despite this, these results have not been sufficiently evaluated. OBJECTIVE: to determine whether the reconciliation procedure is effective in the prevention ofmedication errors audlor to improve the outcome ofhealth care. Methodology: searchers were carried out in differem electronic databases (MEDLINE, EMBASE, Scielo, Cochrane) and grey literature bases. Controlled and Randomised Clinical Trials (CCTs and CRTs) were selected and in their absence, other research designs (non randomised clinical trials or quasi-experimental studies) were selected. The participants were subjectsfrom all age groups, Thefollowing results were included: rehospitalisations, visits to the ER, adverse events to drugs and mortality. Two foreign reviewers extracted the data and independently evaluated the quality ofthe studies using the Jadad scale. RESULTS: 163 articles were located audfour were included to conduct the meta-analysis. The total number ofpatients was 1259. MR significamly reduced the number ofvisits to the ER: (odds ratio 0,66; 95% C1: 0,480,90) and rehospitalisation rates: (odds ratio 0,87; 95% 0: 0,63-1,19). CONCLUSIONS: MR is effective in reducing the rate ofadverse events caused by medication errors and the rate ofvisits to the ER and hospitaUsations.

PURPOSE: Rates of serious medication errors in three pediatric inpatient units (intensive care, general medical, and general surgical) were measured before and after introduction of unit-based clinical pharmacists. METHODS: Error rates on the study units and similar patient care units in the same hospital that served as controls were determined during six- to eight-week baseline periods and three-month periods after the introduction of unit-based clinical pharmacists (full-time in the intensive care unit [ICU] and mornings only on the general units). Nurses trained by the investigators reviewed medication orders, medication administration records, and patient charts daily to detect errors, near misses, and adverse drug events (ADEs) and determine whether near misses were intercepted. Two physicians independently reviewed and rated all data collected by the nurses. Serious medication errors were defined as preventable ADEs and nonintercepted near misses. RESULTS: The baseline rates of serious medication errors per 1000 patient days were 29 for the ICU, 8 for the general medical unit, and 7 for the general surgical unit. With unit-based clinical pharmacists, the ICU rate dropped to 6 per 1000 patient days. In the general care units, there was no reduction from baseline in the rates of serious medication errors. CONCLUSION: A full-time unit-based clinical pharmacist substantially decreased the rate of serious medication errors in a pediatric ICU, but a part-time pharmacist was not as effective in decreasing errors in pediatric general care units.

We present a meta-analysis of 24 effect sizes from transfer of training experiments using whole body simulator motion as an independent variable. Three moderator variables were investigated: experiment design, task type, and subjects’ experience. Due to the large heterogeneity of the included experiments, we used a random-effects model. Correction for measurement error was applied. The results revealed an overall transfer effect in favor of motion (d = 0.51). Effects were weaker in true transfer (d = 0.10) than in quasi-transfer with different (d = 0.73) and identical (d = 1.19) motion, stronger for helicopter (d = 0.86) and disturbance tasks (d = 0.84) than for maneuvering fixed-wing aircraft (d = 0.07), and stronger for subjects without flight experience (d = 1.57) than for pilots with intermediate (d = 0.53) and expert (d = −0.01) experience. In conclusion, motion seems important for flight-naive individuals learning tasks with external disturbances or control of vehicles with low dynamic stability, but not for experts learning fixed-wing aircraft maneuvering tasks. Effects are attenuated in true transfer as compared to quasi-transfer. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

The Institute of Medicine's report To Err Is Human described the alarming prevalence of medical errors and recommended a range of activities to improve patient safety. Three general mechanisms for stimulating hospitals to reduce medical errors are professionalism, regulation, and market forces. Although some believe that market forces are becoming more important, we found that a quasi-regulatory organization (the Joint Commission on Accreditation of Healthcare Organizations) has been the primary driver of hospitals' patient-safety initiatives. Professional and market initiatives have also facilitated improvement, but hospitals report that these have had less impact to date.

BACKGROUND: Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). METHODS: We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. RESULTS: We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it. CONCLUSIONS: Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)

CONTEXT: Trainees are exposed to medical errors throughout medical school and residency. Little is known about what facilitates and limits learning from these experiences. OBJECTIVE: To identify major factors and areas of tension in trainees' learning from medical errors. DESIGN, SETTING, AND PARTICIPANTS: Structured telephone interviews with 59 trainees (medical students and residents) from 1 academic medical center. Five authors reviewed transcripts of audiotaped interviews using content analysis. RESULTS: Trainees were aware that medical errors occur from early in medical school. Many had an intense emotional response to the idea of committing errors in patient care. Students and residents noted variation and conflict in institutional recommendations and individual actions. Many expressed role confusion regarding whether and how to initiate discussion after errors occurred. Some noted the conflict between reporting errors to seniors who were responsible for their evaluation. Learners requested more open discussion of actual errors and faculty disclosure. No students or residents felt that they learned better from near misses than from actual errors, and many believed that they learned the most when harm was caused. CONCLUSIONS: Trainees are aware of medical errors, but remaining tensions may limit learning. Institutions can immediately address variability in faculty response and local culture by disseminating clear, accessible algorithms to guide behavior when errors occur. Educators should develop longitudinal curricula that integrate actual cases and faculty disclosure. Future multi-institutional work should focus on identified themes such as teaching and learning in emotionally charged situations, learning from errors and near misses and balance between individual and systems responsibility.