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Biomedical subjects

E L Allan

Publications and source records attributed to E L Allan.

8 recordsLinked to original sources
PubMed1995

Comparison of medication errors in an American and a British hospital.

Medication errors in a hospital in the United States and a hospital in the United Kingdom were compared. The study was conducted in wards with a high oral-drug-related workload in two large university hospitals. The U.S. hospital was studied in August 1993 and the U.K. hospital in May and June 1993. The U.S. hospital had a typical unit dose drug distribution system, and the U.K. hospital had the ward-based system commonly used in that country, in which a pharmacist visits each ward several times daily and reviews each patient's medication chart. The medication chart is used by the physician to order drugs and obviates the need for transcription of orders. A disguised-observation technique was used to determine frequencies and types of medication errors. Medication errors were identified retrospectively in the U.S. hospital by comparing the observer's notes with the original drug orders made in the patient's chart by the physician. In the U.K. hospital, identification of errors took place concurrently; as doses were administered, they were compared with the orders on the medication chart. In the U.S. and U.K. hospitals, 919 and 2756 opportunities for error were observed, respectively. The medication error rate in the U.S. hospital was 6.9% (95% confidence interval [CI], 5.2% to 8.5%), significantly higher than the 3.0% rate observed in the U.K. hospital (95% CI, 2.4% to 3.7%) (95% CI for the difference, 2.1% to 5.7%). Omitted doses and incorrect doses were the most common types of errors in the U.K. hospital; incorrect doses and unordered doses were the most common types in the U.S. hospital. An American hospital with a unit dose distribution system had a significantly higher medication error rate than a British hospital with a ward-based supply system.

Hospitals, University↗
PubMed1995

Design and evaluation of a sterile compounding facility.

The design and evaluation of a sterile compounding center for a large community teaching hospital are described. The new sterile products area was redesigned to improve efficiency by minimizing staff travel and to incorporate recommendations of the ASHP Technical Assistance Bulletin on Quality Assurance for Pharmacy-prepared Sterile Products. The design approach combined strategic planning with master facilities planning. The process began with a systems analysis, followed by the development of a functional program (a comprehensive list of design specifications). Travel studies were performed before and after renovation to determine gains in efficiency; technician travel decreased 29% and pharmacist travel, 42%. The new facility design met the specifications in the functional program and appeared to comply with all recommendations in the ASHP document for all risk levels of preparations.

Drug Compounding↗
PubMed1995

Dispensing errors and counseling in community practice.

A disguised-patient technique was used to study the nature and frequency of dispensing errors and quality of patient medication counseling in 100 randomly selected community pharmacies. Analysis of 100 prescription orders dispensed detected 24 dispensing errors, of which 4 were clinically significant. Oral counseling was provided to 64 of the patients, covering an average of 3 of the 14 categories of drug information that the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requires pharmacists to consider when counseling Medicaid patients. In addition to prescriber's label instructions, pharmacists provided written counseling information, including auxiliary labels and receipts, to 98% of the patients, but it covered only an average of six OBRA '90 categories. The results suggest that problems with the quality of community pharmacy medication counseling and dispensing accuracy require immediate attention.

Adult↗
PubMed1994

Subjects presented at ASHP Midyear Clinical Meetings, 1967-90.

The subject matter and trends of presentations made at ASHP Midyear Clinical Meetings (MCMs) were studied. A computerized database of information from MCM and Annual Meeting (AM) program and abstract books was created. The data were analyzed to determine the distribution of MCM presentations by subject and by author for the period 1967 to 1990, determine if there were differences in subjects covered between MCMs and AMs, explore the proposition that there has been duplication of material in MCM presentations, and evaluate the frequency with which MCM presentations have been published in ASHP journals. The total number of presentations made at MCMs from 1967 through 1990 was 8180, while the total for the AMs was 1547 for the two periods (1962-71 and 1985-90) studied. The most common keywords in titles were "pharmacy," "drug," "patient," "hospital," and "service." All International Pharmaceutical Abstracts subject categories and two other categories were represented; presentations in the institutional pharmacy practice category were the most frequent, while pharmacognosy-related presentations were least frequent. The overwhelming number of authors made only one presentation and were listed as the first author. The subjects of presentations were similar between AMs and MCMs. A tendency toward duplication of material was found. Of the 8180 MCM presentations, at least 1005 were published in an ASHP journal. Between 1967 and 1990, presentations at MCMs covered a wide range of subjects but were sometimes duplicative or not on the cutting edge.

Abstracting and Indexing↗
PubMed1990

Fundamentals of medication error research.

Types of medication errors are defined, error detection techniques are described, and the validity of several medication error studies is evaluated. A medication error is generally defined as a deviation from the physician's medication order as written on the patient's chart. In hospitals, medication errors occur at a rate of about one per patient per day. A dispensing error is one made by pharmacy staff when distributing medications to nursing units or directly to patients in an ambulatory-care pharmacy; the error rates for doses dispensed via the cart-filling process range from 0.87% to 2.9%. Categories of medication errors should be operationally defined before an investigation, and any allowable deviations from the physician's order should be clearly stated. Fourteen error category definitions are presented. Methods for detecting medication errors include anonymous self-reports (questionnaires), incident reports, the critical-incident technique (analyses of a large number of individual errors to identify common causal factors), and direct observation (including the disguised-observation and participant observer techniques). Observation is the best error detection method in terms of accuracy. Results of medication error studies were examined for validity and classified into one of four categories: (A) results should be accepted as reported, (B) results overestimate or underestimate the truth by a known amount, (C) results overestimate the truth by an unknown amount, and (D) results should not be accepted. All studies examined for validity used observation as the error detection technique. The following guidelines for observation-based medication error studies were established: The observer should follow the subject to the patient's bedside, the observer should witness patient consumption of each dose, the observer should not be familiar with patient drug regimens before observation, operational definitions must be used, and having an error validation committee can be advantageous. Future studies are needed that focus on the identification and testing of new error prevention methods that use the techniques described.

Data Collection↗
PubMedDate not supplied

Patient treatment adherence. Facility design and counseling skills.

OBJECTIVE: To describe the essential facility characteristics for a model patient counseling area: (1) activities that should be accommodated by the facility; (2) special environmental and interior design features, with a discussion of their impact on the healthcare provider-patient interaction; (3) storage and equipment requirements; and (4) determination of space requirements for the counseling area. A second objective is to suggest a strategy to follow when justifying an adherence clinic. DATA SOURCE: Primary and secondary sources of literature were reviewed in the areas of pharmacy, psychology, and architecture to identify design specifications for the patient counseling area. CONCLUSIONS: The design of a counseling area can indirectly affect the quality of the interaction between the patient and healthcare provider, primarily in terms of its effect on communication. The key features that should be included in the design of the area are different levels of privacy (visual and auditory), "soft" interior decoration, and accommodation of people with disabilities. There are several design-related barriers to communication that should be avoided in the facility. The space required for a counseling area is dependent upon the scope of services provided--approximately 100-130 square feet may be necessary.

Ambulatory Care Facilities↗