Medication errors room: a simulation to assess the medical, nursing and pharmacy staffs' ability to identify errors related to the medication-use system

被引:22
作者
Daupin, Johanne [1 ]
Atkinson, Suzanne [1 ,2 ]
Bedard, Pascal [1 ,2 ]
Pelchat, Veronique [3 ]
Lebel, Denis [1 ,2 ]
Bussieres, Jean-Francois [1 ,2 ]
机构
[1] CHU St Justine, Pharm Practice Res Unit, 3175 Chemin Cote St Catherine, Montreal, PQ H3T 1C5, Canada
[2] CHU St Justine, Dept Pharm, 3175 Chemin Cote St Catherine, Montreal, PQ H3T 1C5, Canada
[3] CHU St Justine, Dept Nursing, Montreal, PQ, Canada
关键词
continuous quality improvement; medication error; medication-use system; patient safety; professional practice; simulation-based training; ADVERSE DRUG EVENTS; PEDIATRIC INPATIENTS; CONTROLLED-TRIAL; INTENSIVE-CARE; SERIOUS GAME; STUDENTS; HOSPITALS; EDUCATION; SAFETY;
D O I
10.1111/jep.12558
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Rationale, aims and objectivesThe medication-use system in hospitals is very complex. To improve the health professionals' awareness of the risks of errors related to the medication-use system, a simulation of medication errors was created. The main objective was to assess the medical, nursing and pharmacy staffs' ability to identify errors related to the medication-use system using a simulation. The secondary objective was to assess their level of satisfaction. MethodThis descriptive cross-sectional study was conducted in a 500-bed mother-and-child university hospital. A multidisciplinary group set up 30 situations and replicated a patient room and a care unit pharmacy. All hospital staff, including nurses, physicians, pharmacists and pharmacy technicians, was invited. Participants had to detect if a situation contained an error and fill out a response grid. They also answered a satisfaction survey. ResultsThe simulation was held during 100hours. A total of 230 professionals visited the simulation, 207 handed in a response grid and 136 answered the satisfaction survey. The participants' overall rate of correct answers was 67.5%13.3% (4073/6036). Among the least detected errors were situations involving a Y-site infusion incompatibility, an oral syringe preparation and the patient's identification. Participants mainly considered the simulation as effective in identifying incorrect practices (132/136, 97.8%) and relevant to their practice (129/136, 95.6%). Most of them (114/136; 84.4%) intended to change their practices in view of their exposure to the simulation. ConclusionsWe implemented a realistic medication-use system errors simulation in a mother-child hospital, with a wide audience. This simulation was an effective, relevant and innovative tool to raise the health care professionals' awareness of critical processes.
引用
收藏
页码:907 / 916
页数:10
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