Advertisement
Perioperative Drug Errors & ADEs

Perioperative Drug Errors & ADEs

While much attention has been given to errors in various areas of medicine, few studies have explored perioperative medication error rates. “Much of the available research on perioperative medication errors comes from self-reported data, which can underrepresent true error rates,” explains Karen C. Nanji, MD, MPH. She adds that there can be less double-checking during surgery than on inpatient wards because of the rapidity with which a patient’s condition can change in the operating room. To address this issue from a different perspective, Dr. Nanji and colleagues at Massachusetts General Hospital had an observational study published in Anesthesiology that assessed rates of perioperative medication errors and adverse drug events (ADEs) as percentages of medication administrations. For the study, four anesthesia-trained clinician-researchers observed 225 anesthesia providers during 277 randomly selected operations over 8 months. The observers documented every medication administration, potential medication error, and ADE. An expert adjudication panel reviewed all observer notes as well as chart data from the anesthesia information management system for all potential medication errors and ADEs. This was done in order to determine whether or not they constituted true medication errors or ADEs. The investigators then classified events by severity and whether or not they could have been prevented. Important Findings Overall, 124 of the 277 observed operations included at least one medication error or adverse drug event. “One in 20 perioperative medication administrations included a medication error and/or an ADE,” says Dr. Nanji. In addition, almost 80% of the medication errors and ADEs were determined to have been preventable. Although about 21% of the errors had little potential for harm, one-third led to an...

Analyzing Outcomes for Adults Admitted to Trauma Centers

Over the past 2 decades, significant improvements in mortality outcomes have been observed in various conditions thanks to emphasizing the need for patients to receive recommended evidence-based care and treatments. Less attention, however, has been paid to outcomes resulting from trauma, even though it is the leading cause of potential lost years of life before the age of 65. “Trends in mortality among trauma patients have not been explored adequately in recent research,” says Turner M. Osler, MD, FACS. In an effort to fill this void, Dr. Osler and colleagues conducted a study to determine whether or not mortality rates have improved in trauma patients like they have in other disease states. Published in the Archives of Surgery, the analysis examined longitudinal trends in overall mortality of injured patients who were admitted to level I or level II trauma centers using registry data. A secondary analysis stratified the data by injury severity. Fewer Trauma Mortalities In the study, Dr. Osler and colleagues examined the medical records of nearly 209,000 patients admitted to EDs with injuries who were treated for trauma in 28 hospitals throughout Pennsylvania. Most patients involved in the study were men, but the proportion of patients with mild, moderate, and severe injuries was similar. Blunt trauma and car accidents were the most common causes of trauma, but gunshot wounds, low falls, pedestrian injuries, and stabbings were also reported in the data. “It’s likely that several factors may be responsible for helping people survive trauma.” When comparing 2000-2001 data with that from 2008-2009, the overall mortality rate for patients with moderate injuries decreased by 29% (Figure), and the...
At the Boiling Point: Physician Burnout & Work-Life Balance

At the Boiling Point: Physician Burnout & Work-Life Balance

Previous research has indicated that many physicians throughout the United States experience professional burnout, a syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Studies suggest that burnout can reduce quality of care and increase risks for medical errors, among other negative consequences. Furthermore, there are other adverse personal consequences for physicians that have been linked to burnout, including contributions to broken relationships, problematic alcohol use, and suicidal ideation (read guest blogger, Dr. Rob’s, Top 10 Burnout Triggers). “We have limited data characterizing physician burnout, but few studies have evaluated rates of burnout among U.S. physicians nationally,” says Colin P. West, MD, PhD. “Previous investigations have speculated on which medical or surgical specialty areas are at higher risk, but these analyses have not been definitive.” He adds that research is also lacking on how rates of burnout for physicians compare with rates for U.S. workers in other fields. Medical Specialty Matters in Burnout In the Archives of Internal Medicine, Dr. West and colleagues published a study on burnout involving a large sample of U.S. physicians from all specialty disciplines using the American Medical Association Physician Masterfile. Surveys were used to assess the prevalence of emotional exhaustion, enthusiasm dissipation, cynicism, depression, suicidal tendencies, negative views on work-life balance, and low professional esteem among physicians. After collecting responses from 7,288 physicians from various healthcare settings, 45.8% reported experiencing at least one symptom of professional burnout. “We observed substantial differences in burnout by specialty,” says Dr. West (Figure). The highest rates of burnout were seen in physicians at the front lines of care, most notably family doctors, general...

ACEP 2012: Identifying Factors Associated With ED Physician Medical Errors

The Particulars: For patients who are hospitalized after presenting to the ED, adverse events resulting from medical errors made from emergency physicians have been documented. Factors associated with these events are not well known. Data Breakdown: A prospective observational study of 197 patients who were seen in the ED and subsequently hospitalized detected 130 errors. Of these errors, 34 were categorized as adverse events. Of these adverse events, 66% were categorized as “proficiency errors.” A transition of care involving a handoff within the ED and involvement of a resident in addition to the senior physician were factors associated with a lower risk of adverse events. Take Home Pearls: Involving more than one physician in the care of ED patients appears to be associated with a lower risk of adverse events. This potential benefit warrants investigation in larger prospective studies. For more from ACEP 2012, visit...
[ HIDE/SHOW ]