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Biomedical subjects

Ginette A Pepper

Publications and source records attributed to Ginette A Pepper.

7 recordsLinked to original sources
PubMed2007

Nursing home error and level of staff credentials.

Providing safe nursing home care is both a clinical and fiscal challenge in many countries. The fiscal realities result in the addition of other workers, such as medication technicians or aides (CMT/A), to the health care team. The purpose of this study was to determine the impact of various levels of credentialing among nursing home staff who deliver medications (RN, LPN, or CMT/A) on medication error. In addition, the impact of distractions and interruptions was explored. Using naïve observation, 39 medication administrators representing various levels of credentialing were unobtrusively observed to determine the number of medication errors, distractions, and interruptions in five nursing homes. There were no differences in medication error rates by level of credential. However, RNs had more interruptions during their medication administration, and these increased interruptions were associated with increased medication error rates when wrong time errors were excluded (p = .0348).

Credentialing↗
PubMed2006

Assessing the appropriateness of pain medication prescribing practices in nursing homes.

OBJECTIVES: To test a tool for screening the quality of nursing home (NH) pain medication prescribing. DESIGN: Validity and reliability of measurement tool developed for a pre/postintervention with untreated comparison group. SETTING: Six treatment NHs and six comparison NHs in rural and urban Colorado. PARTICIPANTS: NH staff, physicians, and repeated 20% random sample of each home's residents (N = 2,031). INTERVENTION: Nurse and physician education; NH internal pain team to champion better pain management using a pain vital sign, consultations, and rounds. MEASUREMENTS: An expert panel reviewed the Pain Medication Appropriateness Scale (PMAS) for content validity. Research assistants interviewed NH residents, assessed them for pain using standardized instruments, and reviewed their medical records for prescriptions and use of pain and adjuvant medication. Construct validity was assessed by comparing the PMAS of residents in pain with the PMAS of those not in pain and comparing scores in homes in which the intervention was more effective with those in which it was less effective, using the Fisher exact and Student t tests. Interrater and test-retest reliability were measured. RESULTS: The mean total PMAS was 64% of optimal. Fewer than half of residents with predictably recurrent pain were prescribed scheduled pain medication; 23% received at least one high-risk medication. PMAS scores were better for residents not in pain (68% vs 60%, P = .004) and in homes where nurses' knowledge of pain assessment and management improved or stayed the same during the intervention (69% vs 61%, P = .03). CONCLUSION: The PMAS is useful for assessing pain medication prescribing in NHs and elucidates why so many residents have poorly controlled pain.

Adult↗
PubMed2006

Barriers to nurses' reporting of medication administration errors in Taiwan.

PURPOSE: To describe nurses' perceptions of reporting barriers to reporting medication administration errors (MAE) and to examine the relationship between the barriers to MAE reporting and cultural factors and nursing work environment in Taiwan. METHODS: A cross-sectional, descriptive correlational design with self-administered questionnaires was conducted in one large medical center hospital in southern Taiwan. The measurement tools included the Chinese versions of the Work Environment Questionnaire, Barriers to MAE Reporting, Index of Hierarchy of Authority, and Face-Concern scale. A mail survey of 807 nurses using the Total Design Method was implemented for data collection with 597 questionnaires used in data analyses. FINDINGS: The major perceived barrier was fear. Regression analysis showed that power hierarchy, face-saving concern, and work environment factors (e.g., quality management and peer relations) accounted for 54.6% variance in the barriers. Age, educational background, working experience, experience of having made MAEs, and failure to report MAEs were not associated with the barriers. CONCLUSIONS: Taiwanese nurses perceived similar barriers to MAE reporting. The more power hierarchy and face-saving concern the nurses agreed on, the more barriers they perceived. The association between the barriers and nursing work environment was negative and weak.

Adult↗
PubMed2006

Balancing acts: deciding for or against antibiotics in acute respiratory infections.

BACKGROUND: Overprescribing of antibiotics for acute respiratory infections (ARIs) has contributed to antibiotic resistance. Multiple clinician, patient, and system-related factors contribute to the prescribing of antibiotics for ARIs; however, these factors do not explain how clinicians arrive at their decisions to prescribe antibiotics. The purpose of our study was to describe this decision-making process. METHODS: We conducted comprehensive interviews with 21 primary health care clinicians practicing in a rural Western US community. Our study used a qualitative descriptive design informed by grounded theory, and we analyzed data with a constant comparative method. RESULTS: Two theoretical concepts emerged from the interviews: 1) individual best practice described how each clinician attempted to do what he or she believed to be clinically best for the patient presenting with acute respiratory symptoms. The second concept, perceived patient satisfaction, described how the clinicians endeavored to satisfy patients, according to their own perceptions of the patient's potential to be satisfied. 2) Balancing acts emerged as the basic social process and is defined as the process whereby clinicians weigh individual best practice against perceived patient satisfaction when deciding whether to prescribe antibiotics for patients presenting with ARIs. CONCLUSION: The results of this investigation have important clinical and educational implications for reducing inappropriate antibiotic use for ARIs. Further controlled trials are warranted.

Acute Disease↗
PubMed2002

Medication errors observed in 36 health care facilities.

BACKGROUND: Medication errors are a national concern. OBJECTIVE: To identify the prevalence of medication errors (doses administered differently than ordered). DESIGN: A prospective cohort study. SETTING: Hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations, nonaccredited hospitals, and skilled nursing facilities in Georgia and Colorado. PARTICIPANTS: A stratified random sample of 36 institutions. Twenty-six declined, with random replacement. Medication doses given (or omitted) during at least 1 medication pass during a 1- to 4-day period by nurses on high medication-volume nursing units. The target sample was 50 day-shift doses per nursing unit or until all doses for that medication pass were administered. METHODS: Medication errors were witnessed by observation, and verified by a research pharmacist (E.A.F.). Clinical significance was judged by an expert panel of physicians. MAIN OUTCOME MEASURE: Medication errors reaching patients. RESULTS: In the 36 institutions, 19% of the doses (605/3216) were in error. The most frequent errors by category were wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). Seven percent of the errors were judged potential adverse drug events. There was no significant difference between error rates in the 3 settings (P =.82) or by size (P =.39). Error rates were higher in Colorado than in Georgia (P =.04) CONCLUSIONS: Medication errors were common (nearly 1 of every 5 doses in the typical hospital and skilled nursing facility). The percentage of errors rated potentially harmful was 7%, or more than 40 per day in a typical 300-patient facility. The problem of defective medication administration systems, although varied, is widespread.

Accreditation↗
PubMed2002

Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities.

The validity and cost-effectiveness of three methods for detecting medication errors were examined. A stratified random sample of 36 hospitals and skilled-nursing facilities in Colorado and Georgia was selected. Medication administration errors were detected by registered nurses (R.N.s), licensed practical nurses (L.P.N.s), and pharmacy technicians from these facilities using three methods: incident report review, chart review, and direct observation. Each dose evaluated was compared with the prescriber's order. Deviations were considered errors. Efficiency was measured by the time spent evaluating each dose. A pharmacist performed an independent determination of errors to assess the accuracy of each data collector. Clinical significance was judged by a panel of physicians. Observers detected 300 of 457 pharmacist-confirmed errors made on 2556 doses (11.7% error rate) compared with 17 errors detected by chart reviewers (0.7% error rate), and 1 error detected by incident report review (0.04% error rate). All errors detected involved the same 2556 doses. All chart reviewers and 7 of 10 observers achieved at least good comparability with the pharmacist's results. The mean cost of error detection per dose was $4.82 for direct observation and $0.63 for chart review. The technician was the least expensive observer at $2.87 per dose evaluated. R.N.s were the least expensive chart reviewers at $0.50 per dose. Of 457 errors, 35 (8%) were deemed potentially clinically significant; 71% of these were detected by direct observation. Direct observation was more efficient and accurate than reviewing charts and incident reports in detecting medication errors. Pharmacy technicians were more efficient and accurate than R.N.s and L.P.N.s in collecting data about medication errors.

Chi-Square Distribution↗