Environmental Issues Related to Medication Errors in Long-Term Care: Lessons From the Literature
2009
HERD: Health Environments Research & Design Journal
Journal Article
Issue 2
Volume 2
Pages 42-59
Author(s): Mahmood, A., Chaudhury, H., Gaumont, A.
Medication errors contribute significantly to patient illness and mortality and are costly to the healthcare system. This is especially true for elderly patients in long-term care facilities. While the specific definition of medication error often varies from study to study, these errors typically occur when a physician's orders, the manufacturer's guidelines, or professional best practices in drug, dose, route, or timing are not properly followed. They can arise during ordering, dispensing, or administering medication.
Added September 2014
Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit
2009
American Journal of Health-System Pharmacy
Journal Article
Issue 12
Volume 66
Pages 1110-5
Author(s): DeYoung, J. L., Vanderkooi, M. E., Barletta, J. F.
Added September 2014
Influence of Role Models and Hospital Design on the Hand Hygiene of Health-Care Workers
2003
Emerging Infectious Diseases
Journal Article
Issue 2
Volume 9
Pages 217-223
Author(s): Lankford, M. G., Zembower, T. R., Trick, W. E., Hacek, D. M., Noskin, G. A., Peterson, L. R.
One of the key components for limiting spread of healthcare–associated infectious disease is the practice of adequate infection control. A cornerstone of infection control is ensuring that healthcare workers wash their hands at appropriate times. Some reports suggest that role models, group behavior, and the level of managerial support influence reported levels of compliance. However, few studies have prospectively evaluated the association between hand-hygiene compliance and building design.
Added July 2014
Long-term care physical environments- effect on medication errors
2012
International Journal of Health Care Quality Assurance
Journal Article
Issue 5
Volume 25
Pages 431-441
Author(s): Mahmood, A., Chaudhury, H., Gaumont, A., Rust, T.
Medication errors contribute significantly to patient morbidity and mortality, and are associated with considerable healthcare costs, as well. The human and financial costs following preventable medical errors are high; data in the United States suggest an estimated 44,000 inpatients die each year from preventable medical errors. Nationally, preventable adverse event costs have been estimated at $17 billion.
Added July 2014
Applying human factors in improving medication-use safety
2002
American Journal of Health-System Pharmacy
Journal Article
Issue 12
Volume 59
Pages 1155-1159
Author(s): Schneider,PJ.
In this descriptive study the author summarizes the highlights of an interactive conference on human factors (HF) and t applications to improve medication safety. The author describes the various human factors concepts and tools and their applications in reducing human errors, thus improving medication safety.
Added May 2014
Effects of Acuity-Adaptable Rooms on Flow of Patients and Delivery of Care
2004
American Journal of Critical Care
Journal Article
Author(s): Hendrich, A. L., Fay, J., Sorrells, A.
Acuity-adaptable rooms could reduce patient transfer times, decrease costs, and increase patient quality of care and satisfaction. Researchers conducted a pre/post study in an acute care setting to evaluate the impact of moving to acuity-adaptable rooms on patient flow, hospital capacity, patient and staff satisfaction, sentinel events, average length of stay, and nursing productivity.
Added May 2014
Considering the impact of medicine label design characteristics on patient safety
2006
Ergonomics
Journal Article
Issue 5-6
Volume 49
Pages 617-30
Author(s): Hellier, E. , Edworthy, J. , Derbyshire, N. , Costello, A.
The premise of this study is that there is sufficient evidence-based research in areas such as food labeling, chemical labeling, and general warnings that provides systematic evidence on the effects of medication label design characteristics such as font size, color, use of specific language and signal words/warnings on performance behavioral variables such as safety, compliance, understandability, and discriminability.
Added April 2014
The Effect of Environmental Design on Reducing Nursing Errors and Increasing Efficiency in Acute Care Settings: A Review and Analysis of the Literature
2009
Environment and Behavior
Journal Article
Issue 6
Volume 41
Pages 755-786
Author(s): Chaudhury, H., Mahmood, A., Valente, M.
In acute care settings, the physical environment plays an important role in staff efficiency and patient safety. Some research suggests that poor environments can result in staff stress, anxiety, and distractions due to noise; artificial lighting; improper or inadequate ventilation; and disorienting layouts of nursing units. There is less research on how environmental factors affect nursing staff health, effectiveness, errors, and job satisfaction.
Added April 2014
Medication Errors Observed in 36 Healthcare Facilities
2002
Archives of Internal Medicine
Journal Article
Issue 16
Volume 162
Pages 1897-1903
Author(s): Barker, K. N., Flynn, E. A., Pepper, G. A., Bates, D. W., Mikeal, R. L.
The authors in this study aimed to measure and compare the medication error rates at 36 healthcare facilities in Georgia and Colorado. Three different facility types were randomly stratified and included in the study; Joint Commission accredited hospitals, Joint Commission non-accredited hospitals and skilled nursing facilities. The main aim was to observe if the medication error rates in these healthcare settings differ by facility type (by bed size) or by State.
Added April 2014
No Interruptions Please: Impact of a No Interruption Zone on Medication Safety in Intensive Care Units
2010
Critical Care Nurse
Journal Article
Issue 3
Volume 30
Pages 21-29
Author(s): Anthony, K., Wiencek, C., Bauer, C., Daly, B., Anthony, M. K.
The authors conducted a quasi-experimental study to study the impact of a No Interruption Zone (NIZ)
Added April 2014
Incidents relating to the intra-hospital transfer of critically ill patients
2004
Intensive Care Medicine
Journal Article
Issue 8
Volume 30
Pages 1579-1585
Author(s): Beckmann, U., Gillies, D. M., Berenholtz, S. M., Wu, A. W., Pronovost, P.
Transportation of critically ill patients between hospitals can increase complications. Intrahospital transportation poses many of the same risks. Examining these incidents could uncover ways to improve patient safety during transportation.
Added April 2014
Using a Task Analysis to Describe Nursing Work in Acute Care Patient Environments
2009
Journal of Nursing Administration
Journal Article
Issue 12
Volume 39
Pages 537-547
Author(s): Battisto, D., Pak, R., Vander Wood, M. A., Pilcher, J. J.
A growing body of research demonstrates linkages between workplace design and processes in healthcare facilities with staff and patient safety, operational efficiency, staff satisfaction, and medical errors. There has been less emphasis on the role of the built environment in helping or hindering care delivery. Research is needed on the contextualized activities performed by nurses and how nurses spend their time to measure the effects of interventions aimed at redesigning care to improve safety or efficiency or to understand the implications of policy changes for nursing practice.
Added April 2014
Review of the Literature: Acuity-Adaptable Patient Room
2013
Critical Care Nursing Quarterly
Journal Article
Issue 2
Volume 36
Pages 251–271
Author(s): Bonuel, N. , Cesario, S.
Acuity-adaptable rooms allow patients to stay in one room from the time they are admitted to when they leave, regardless of their acuity level. These specially equipped private rooms are staffed by nurses who have the skills and training to support the complete range of care for patients with similar conditions or disease processes. The rooms are larger in size than a regular hospital room to accommodate various patients’ needs as their condition changes, such as critical care equipment, additional staff, procedures, and family members.
Added March 2014
Threading Needles in the Dark: The Effect of the Physical Work Environment on Nursing Practice
2009
Critical Care Nursing Quarterly
Journal Article
Issue 1
Volume 32
Pages 70–74
Author(s): Simmons, D., Graves, K., Flynn, E. A.
People’s ability to perform reliably and safely relies on the physical work environment. Nowhere is this connection more critical than in healthcare environments, which can be noisy, dimly lit, and chaotic. The United States Pharmacopeia addresses this issue in its draft general chapter of standards, “Physical Environments that Promote Safe Medication Use,” which specifies work environment guidelines to support efficient and safe medication use.
Added February 2014
Nurses’ Perceptions of How physical Environment Affects Medication Errors in Acute Care Settings
2011
Applied Nursing Research
Journal Article
Issue 4
Volume 24
Pages 229–237
Author(s): Mahmood, A., Chaudhury, H., Valente, M.
Medication errors in hospitals occur for a number of reasons, stemming from staff and organizational issues to aspects of the physical environment. Errors include omissions, giving the wrong type or amount of medication, and giving the wrong patient unneeded medication. Research has indicated that a significant amount of these errors are avoidable.
Added February 2014
Same-Handed and Mirrored Unit Configurations: Is There a Difference in Patient and Nurse Outcomes?
2011
Journal of Nursing Administration
Journal Article
Issue 6
Volume 41
Pages 273-279
Author(s): Watkins, N., Kennedy, M., Ducharme, M., Padula, C.
Awareness of the impact of healthcare facility design on a number of diverse patient and staff outcomes is growing. From patient recovery time, satisfaction, and comfort to nursing staff efficiency, error rates, and distraction, varied outcomes are being linked to environmental conditions and design attributes in hospital settings. Inpatient unit configurations, specifically same-handed configurations vs. mirrored units, are a particular area of interest for researchers, with implications for practitioners and patient care. Same-handed configurations, which standardize all rooms within a unit such that they are all identical, may allow for reduced noise as headwalls are no longer shared.
Added February 2014
Impact of Medication Storage Cabinets on Efficient Delivery of Medication and Employee Frustration
2010
Journal of Nursing Care Quality
Journal Article
Issue 4
Volume 25
Pages 352-357
Author(s): Hull, T., Czirr, L. , Wilson, M.
Safe medication administration is essential to ensuring positive patient outcomes and is a priority in healthcare institutions. Recent innovations in technology and automation are designed to eliminate errors as well as move activities closer to the patient’s bedside to improve nursing workflow. It has been postulated that moving medications and supplies closer to the point of care reduces nurses’ traveling time and makes it easier to administer medication.
Added January 2014
Direct cellular vs. indirect pager communication during orthopaedic surgical procedures: A prospective study
2009
Technology and Health Care
Journal Article
Issue 2
Volume 17
Pages 149-157
Author(s): Ortega, G. R., Taksali, S., Smart, R., Baumgaertner, M. R.
Staff-to-staff communication is critical to quality and efficient healthcare. Physicians, nurses, and other healthcare workers all use various methods of communication in their daily work. Difficulties in staff communication often lead to interruptions and delays in patient care, variation in response time, medical errors, violation of privacy, and dissatisfaction in patient and staff.
Added October 2012
Illumination and errors in dispensing
1991
American Journal of Hospital Pharmacy
Journal Article
Issue 10
Volume 48
Pages 2137-45
Author(s): Buchanan, T.L., Barker, K.N., Gibson, T., Pearson, R.E.
Added October 2012
Medication Dispensing Errors in Community Pharmacies: A Nationwide Study
2002
Proceedings of the Human Factors and Ergonomics Society Annual Meeting
Journal Article
Issue 16
Volume 46
Pages 1448-1451
Author(s): Flynn, E. A., Dorris, N. T., Holman, G. T., Camahan, B. J., Barker, K. N
The available literature concerning medication dispensing errors provides relatively few studies that focus on community-based pharmacies, as much of the available research regarding dispensing errors has been conducted in single pharmacies that are associated with hospitals and medical centers, largely due to convenience. Although the dispensing process may be essentially the same, the validity of extending these findings to community pharmacies has yet to be tested.
Added October 2012
