Terri L. Warholak

A Prospective Observational Study of Medication Errors in a Tertiary Care Emergency Department

STUDY OBJECTIVE We determine the rate and severity of medication errors, as well as factors associated with error occurrence in the emergency department (ED). METHODS This was a prospective observational study conducted between May 1, 2008, and February 1, 2009. The pharmacist observer was present in the ED for 28 shifts (12 hours each). Information was collected on the medication use process by observing the activities of nurses caring for the patients. Errors were categorized by severity. Logistic regression was used to analyze factors associated with a risk of medication error. RESULTS The observer identified 178 medication errors in 192 patients during the data collection period. At least 1 error occurred in 59.4% of patients, and 37% of patients overall had an error that reached them. No errors in the study resulted in permanent harm to the patient or contributed to initial or prolonged hospitalization; however, interventions were performed to prevent patient harm that likely influenced the severity of error. Errors categorized according to stage were prescribing (53.9%), transcribing (10.7%), dispensing (0.6%), and administering (34.8%). Variables predictive of medication errors were boarded patient status (odds ratio [OR] 2.15; 95% confidence interval [CI] 1.03 to 4.5), number of medication orders (OR 1.25; 95% CI 1.12 to 1.39), number of medications administered (OR 1.22; 95% CI 1.07 to 1.38), and nursing employment status (less error if full time) (OR 0.37; 95% CI 0.16 to 0.86). CONCLUSION Medication errors in the ED are common, and most errors occur in the prescribing and administering phases. Boarded patient status, increasing number of medications orders, increasing number of medications administered, and part-time nursing status are associated with an increased risk of medication error.

Evaluation of Risk Factors and Health Outcomes among Persons with Asthma

Objective: To examine risk factors associated with healthcare utilization in Arizona Medicaid patients with asthma. Methods: Data were obtained from Arizona Medicaid between 1/1/2002 and 12/31/2003. Inclusion criteria consisted of persons with an asthma diagnosis (ICD9-CM 493.XX), 5 to 62 years of age; and were new users of inhaled-corticosteroids (ICS), combination ICS+long-acting beta-agonist, or leukotriene-modifiers. Factors examined included age, geographic location (urban/rural), race/ethnicity (White, non-Hispanic Black, Hispanic, other), medication adherence, pre-period short-acting beta-agonist use (SABA), and co-morbidities. Utilization measures examined included SABA use; exacerbations measured by hospital visits; and asthma-related and total healthcare costs. Analyses for utilization measures were performed using negative binomial, logistic regression, and generalized linear modeling gamma-family, log-link, respectively. Results: A total of 3,013 subjects met inclusion/exclusion criteria and had a mean age (±SD) of 24.7 ±13.7 years. Urban residents were 55% more likely to have an exacerbation than rural residents (odds ratio-OR 0.45, 95%CI: 0.27–0.78). Age (years 18 to 62) was a significant predictor for SABA use (incidence rate ratio-IRR 1.22, 95% CI: 1.06–1.41); and exacerbations (OR 2.07, 95% CI: 1.28–3.38). Mean predicted asthma cost was

The Impact of Health Information Exchange on Health Outcomes

530 (95% CI:

International Normalized Ratio values in group versus individual appointments in a pharmacist-managed anticoagulation clinic

461–608) for ages 5 to 17,

Medication Error Identification Rates by Pharmacy, Medical, and Nursing Students

702 (95% CI

Health Disparities in Cost of Care in Patients With Alzheimer’s Disease: An Analysis Across 4 State Medicaid Populations

600–822) for ages 18 to 39), and

A Cost-Effectiveness Evaluation of Hospital Discharge Counseling by Pharmacists

583 (95% CI

Results of the Arizona Medicaid Health Information Technology Pharmacy Focus Groups

468–726) for ages 40 to 62. Males were 46% less likely to have an exacerbation than females (OR 0.54, 95% CI: 0.31–0.94). Exacerbations were not different between race/ethnicity categories. Predicted mean asthma-related costs were not different between Whites (

Teaching the science of safety in US colleges and schools of pharmacy.

591, 95% CI:

The Educating Pharmacy Students and Pharmacists to Improve Quality program: Tool for pharmacy practice

509–686), Blacks (