Virpi Jylhä

Preventable adverse drug events and their causes and contributing factors: the analysis of register data

OBJECTIVE To identify the causes and contributing factors of adverse drug events (ADEs) from the information management point of view. DESIGN Retrospective study. Official register data were used to analyse preventable ADEs. The data were retrieved from the National Supervisory Authority for Welfare and Health and were analysed using qualitative content analysis, which was mainly based on the classification of ADEs. SETTING National health care system. PARTICIPANTS Patient complaints (n = 16) and official statements about causality of injuries or deaths (n = 41) in which ADEs were present from the years 2001-07. A total of 57 statements were reviewed, and the 67 ADEs that occurred in the statements were analysed. INTERVENTIONS None. MAIN OUTCOME MEASURES Causes, contributing factors, types of errors. RESULTS The majority of ADEs (81%) occurred in inpatients in general health care units (n = 26), in specialized health care units (n = 19) or in nursing homes (n = 10). ADEs occurring in the prescription, transcription (n = 23) and administration (n = 21) stages were the most frequent, and human factors were the leading class of underlying cause followed by the use of data. Error types relating to information management (n = 26) occurred in every phase of the medication use process. The majority of information management errors were related to documentation, copying data or contraindicated prescriptions, and they mainly occurred in the prescription and transcription (n = 11), and admission phases (n = 8). CONCLUSION Information management processes need to be improved to improve medication safety.

Electronic documentation in medication reconciliation - a challenge for health care professionals

Errors in medication care can be lethal; hence in Finland, as in many other countries, increasing attention is being paid to this aspect of patient safety. Previous studies have shown that medication documentation is prone to errors that are due to organisational failures and human error (Hughes & Ortiz, 2005; Mustajoki, 2005; Wagner & Hogan, 1996). Adequate documentation has particular implications for medication reconciliation, which is an important tool for improving patient safety in the hospital environment. Medication reconciliation aims to reduce errors in medication management by compiling accurate medication information for a patient at any point of care. It is applied when a patient is admitted to hospital or transferred to another care unit within or outside the health care organisation (The Joint Commission, 2006, January 25). It is also used when newmedications are prescribed, or when current medication is changed. The electronic patient record (EPR) system has been widely introduced in Finland and is probably the most important factor making for changes in health care (Hamalainen, Reponen, & Winblad, 2007). The EPR has changed the ways in which information is produced and utilized: it is expected to increase access to medication information and to make medication reconciliation more efficient (Hayrinen, Saranto, & Nykanen, 2008). This paper will outline the importance of medication reconciliation when medication information is documented in electronic patient records.

Organization of nursing care in three Nordic countries: relationships between nurses’ workload, level of involvement in direct patient care, job satisfaction, and intention to leave

BackgroundHealth care systems in Finland, Norway and Sweden share many similarities, e.g. full-coverage and tax-financed, with predominately public sector hospitals. Despite similarities, there are differences in the working situations for RNs within these Nordic countries. The aim of this study was to analyze associations between RNs’ patient workload and level of involvement in direct patient care, their job satisfaction and intention to leave in these countries.MethodsA workforce survey was conducted through RN4CAST, an EU 7th framework project. The survey included 118 items derived from validated instruments or tested in prior research. Responses from 1133 RNs at 32 Finnish hospitals, 3752 RNs at 35 Norwegian hospitals, and 11 015 RNs at 71 Swedish hospitals comprise the database, which was analyzed using logistic and odds ratio regressions analyses.ResultsWe found statistically significant differences in RNs’ level of involvement in direct patient care (p < 0.001, Sweden compared to Norway and Finland), in patient workload and in number of patients needing ADL assistance and surveillance. A U-formed relationship was found between level of involvement in direct patient care and intention to leave in Sweden, and more satisfaction among RNs in roles with more direct patient care (OR = 1.16, 1.02 ≤ CI95% ≤ 1.32). Nearly half the Finnish sample report intention to leave, with significantly lower levels in Norway and Sweden (p < 0.001). Patient workload is associated with job satisfaction and intention to leave to some degree in all countries, i.e. greater patient workload, less job satisfaction and greater intention to leave.ConclusionsThis study suggests that more attention paid to patient mix, workload and role of RNs in patient care might potentially diminish intention to leave and increase job satisfaction in these Nordic countries.

Adverse events and near misses relating to information management in a hospital

Objective: This study described information management incidents and adverse event reporting choices of health professionals. Methods: Hospital adverse events reported in an anonymous electronic reporting system were analysed using directed content analysis and descriptive and inferential statistics. The data consisted of near miss and adverse event incident reports (n = 3075) that occurred between January 2008 and the end of December 2009. Results: A total of 824 incidents were identified. The most common information management incident was failure in written information transfer and communication, when patient data were copied or documented incorrectly. Often patient data were transferred using paper even though an electronic patient record was in use. Reporting choices differed significantly among professional groups; in particular, registered nurses reported more events than other health professionals. Conclusion: A broad spectrum of information management incidents was identified, which indicates that preventing adverse events requires the development of safe practices, especially in documentation and information transfer.

A scoping review of nursing workforce planning and forecasting research

AIM This study will critically evaluate forecasting models and their content in workforce planning policies for nursing professionals and to highlight the strengths and the weaknesses of existing approaches. BACKGROUND Although macro-level nursing workforce issues may not be the first thing that many nurse managers consider in daily operations, the current and impending nursing shortage in many countries makes nursing specific models for workforce forecasting important. METHOD A scoping review was conducted using a directed and summative content analysis approach to capture supply and demand analytic methods of nurse workforce planning and forecasting. The literature on nurse workforce forecasting studies published in peer-reviewed journals as well as in grey literature was included in the scoping review. RESULTS Thirty six studies met the inclusion criteria, with the majority coming from the USA. Forecasting methods were biased towards service utilization analyses and were not consistent across studies. CONCLUSION Current methods for nurse workforce forecasting are inconsistent and have not accounted sufficiently for socioeconomic and political factors that can influence workforce projections. Additional studies examining past trends are needed to improve future modelling. IMPLICATIONS FOR NURSING MANAGEMENT Accurate nursing workforce forecasting can help nurse managers, administrators and policy makers to understand the supply and demand of the workforce to prepare and maintain an adequate and competent current and future workforce.

The Impact of Information Culture on Patient Safety Outcomes

Summary Background An organization’s information culture and information management practices create conditions for processing patient information in hospitals. Information management incidents are failures that could lead to adverse events for the patient if they are not detected. Objectives To test a theoretical model that links information culture in acute care hospitals to information management incidents and patient safety outcomes. Methods Reason’s model for the stages of development of organizational accidents was applied. Study data were collected from a cross-sectional survey of 909 RNs who work in medical or surgical units at 32 acute care hospitals in Finland. Structural equation modeling was used to assess how well the hypothesized model fit the study data. Results Fit indices indicated a good fit for the model. In total, 18 of the 32 paths tested were statistically significant. Documentation errors had the strongest total effect on patient safety outcomes. Organizational guidance positively affected information availability and utilization of electronic patient records, whereas the latter had the strongest total effect on the reduction of information delays. Conclusions Patient safety outcomes are associated with information management incidents and information culture. Further, the dimensions of the information culture create work conditions that generate errors in hospitals.

Family members’ experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this systematic review is to identify and synthesize existing evidence of the experiences and expectations of self-management counseling of adult family members (e.g. spouse, adult child) who are informal caregivers of a person with chronic obstructive pulmonary disease. The specific research questions are: What are the experiences of adult family members in self-management counseling of chronic obstructive pulmonary disease? What are the expectations of adult family members in self-management counseling of chronic obstructive pulmonary disease? INCLUSION CRITERIA Types of participants This systematic review will consider studies that include adults (over 18 years) who are family members of individuals with any stage of chronic obstructive pulmonary disease. The concept of family member refers to a person who is an informal caregiver because of a mutual relationship with the person with chronic obstructive pulmonary disease. Furthermore, studies are included if family members have participated in self-management counseling organized by healthcare professionals or have wished or planned to participate. All types of counseling methods are included. Types of phenomena of interest This systematic review will consider studies that investigate family members’ experiences and expectations of chronic obstructive pulmonary disease’s self-management counseling. Context This systematic review will consider studies that investigate family members’ experiences and expectations of chronic obstructive pulmonary disease’s self-management counseling in the context of inpatients or outpatients care.

Effects of Automated Dose-Dispensing System on Medication Management Process

Medication management process in a hospital includes all the work that is done concerning to a certain patient’s medical treatment. According to international studies, the process is very prone to errors, which can cause adverse drug events and endanger the patient safety. In this paper, we will show how medication management process can be improved by a user-centric and computer-based automated dose-dispensing system. We will focus on the changes in medication management process, when the automated dose-dispensing system is implemented into practice. As a result of this implementation, we get a model for decision-making in medication management process and several benefits, like hygienic medication doses, smaller medication warehouses at wards and in the pharmacy. Additionally with the automated dose-dispensing system, pharmacists have to review patients’ medication regimen before dispensing medications in order to identify possible interactions. However, during medication dispensing in the hospital pharmacy, error rate was discovered to be 0.36%. In wards the error rate was 0.013%. Regardless of these, the use reliability of the ADDS was noticed to be 100%.