Changes in both technical and organizational strategies are often required to prevent medication errors, and a combined approach may be superior to making changes in only one of these areas. Unfortunately, it may be difficult to implement changes in both areas, but the incentive of accreditation may be helpful. In addition to the difficulty of implementing changes in ICUs, reports of errors do not always provide guidance for prevention. Weinert and others reported that even when guidance for change was provided, in the form of findings from a randomized controlled trial, the implementation of change was often slow. These difficulties in implementation may explain the finding in our study that only about half of responding ICUs had made changes in reaction to reports of medication errors and adverse drug events. There is clearly great room for improvement in the measurement of medication safety in Canadian ICUs.
One limitation of this study was that the survey response rate at the level of the ICU (39%) was lower than that in other national surveys involving critical care, which had response rates of 76% and 60%. These Canadian surveys were sent to critical care physicians using postal mail and involved a second mailing of the survey and telephone calls to prompt participa- tion. Hebert and others also sent a reminder postcard before the second mailing of the survey. However, other surveys using e-mail and online methods have had response rates similar to ours. For example, Barger and others had a response rate of 18.5% from medical interns. Jones and Pitt compared methods used for health surveys and reported that postal surveys produced a 72% response rate, whereas e-mail surveys yielded a 34% response rate. Phone calls may be more effective than e-mail messages in prompting participation in mail surveys. The response rate in the current study might have been greater if the survey had also been available in French, as the unilingual presentation of the survey might have been a factor discouraging responses from Quebec. The implications of a low response rate include threats to generalizability of the findings. kamagra soft tablets
A second limitation of the study involved the method of survey delivery. The survey was delivered only to ICUs that had a member of the Critical Care PSN of the Canadian Society of Hospital Pharmacists. This meant that Canadian ICUs that did not have a critical care pharmacist and those that had a pharmacist who was not a member of the PSN would not have been reached by the survey and thus would not have been represented. Furthermore, some members of the PSN might not have responded because they did not work in an ICU. A third limitation of the study was the collection of data using a self-report survey format, rather than direct observation. Although collection of data by direct observation would have been superior, it was not feasible for this study.
The strengths of this study include the development of the survey and its assessment for face and content validity by a multidisciplinary team, representation of a variety of ICUs from across Canada in the survey results, and identification of opportunities for improvement in the processes of reporting and acting on medication errors and adverse drug events. Many of these opportunities could be actualized by existing ICU pharmacists.
In summary, most ICUs in Canada that responded to this survey had a method for measuring medication errors, with voluntary reporting by hard-copy (paper) documentation being the most popular method. Although most ICUs had a dedicated ICU pharmacist, only half of the ICUs that measured medication errors and adverse drug events had made changes based on the information from these reports. These findings indicate that there is room for improvement in the standardization of measurement of medication errors and adverse drug events in Canadian ICUs.