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Characteristics of Study Participants
Most of the study participants reported that they consulted drug information databases at least daily in their practice, with 23 (88%) reporting prior access to Micromedex and half or fewer reporting prior access to either Lexi-Comp Online or Clinical Pharmacology (Table 2).
Database Quality
Lexi-Comp Online received the highest mean quality score (2.6), followed by Micromedex (2.2) and Clinical Pharmacology (1.6), although the differences among the databases were not statistically significant (Table 3). Lack of Canadian content in Clinical Pharmacology was a major distinguishing difference between this database and Lexi-Comp Online in the investigators’ assessment. Thematic analysis of study participants’ comments (Table 4) confirmed this deficiency as a distinguishing feature between Clinical Pharmacology and the other databases.
Evaluation of Database Performance
Each study participant used each database to answer a set of 5 randomly assigned drug information questions (total of 15 questions per participant). The order in which study participants evaluated the 3 drug information databases was also randomly assigned, and over the whole study each database was used to attempt to answer each of the 15 questions at least once. In an effort to consume no more than 1 hour of a participant’s time, the participants were asked to spend no more than 3 minutes on each drug information question. Study participants used a 3-point scale to note whether answers to the drug information questions posed were present and complete (see Appendix 1), but the investigators made no attempts to confirm the accuracy of the answers located. The performance score for each database was calculated as the mean score across all 15 questions, with each question weighted equally.
A qualitative and quantitative data collection and analysis strategy, with descriptive and inferential statistics, was used to assess the quality, performance, and usability of the databases and users’ preferences, to determine overall database preference. This study satisfied all ethical review requirements of the investigators’ organization.
INTRODUCTION
The size and complexity of the body of drug information is growing rapidly. This growth in the availability of drug information and the accompanying growth in medication use have necessitated advancement of the role of pharmacists as medication experts within multidisciplinary health care teams, particularly in hospitals. The use of clinical decision support tools such as electronic drug information databases can aid pharmacists in their provision of pharmaceutical care and has the potential to improve medication safety. As such, pharmacists’ access to user-friendly electronic resources that can quickly provide complete, accurate, and current medication information has become increasingly important, especially in hospital pharmacy practice, where clinical pharmacists are often directly involved in the therapeutic decision-making process.
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.
- In: Health
- Tags: intensive care unit, Medication Safety, reporting system
Medication Error Reporting Systems: DISCUSSION
27 Dec2010
This survey was the first to systematically examine the reporting of medication errors and adverse drug events in Canadian ICUs. Responses came from a wide variety of Canadian ICUs, and only 3 provinces were not represented. Responses were obtained almost equally from academic, community teaching, and community nonteaching hospitals. In a similar recently reported survey of ICUs in the United States, most respondents were from nonteaching community institutions. Because of this difference in the responding population, the findings from the US survey may not be applicable to Canadian ICUs and may explain differences such as the rate of use of voluntary reporting systems (94.7% in the US study compared to 73% in this Canadian survey).
- In: Health
- Tags: intensive care unit, Medication Safety, reporting system
Voluntary Reporting
Paper reports were the most popular method (16/26 [62%]) for voluntary reporting of medication errors (Figure 2). Other methods were intranet, phone calls, and Internet (Figure 2). Netsafe, Meditech EMR, and Risk MonitorPro were reported as the web-based systems in use. An internal e-mail system built into the computer system was reported by one ICU. Read the rest of this entry »
- In: Health
- Tags: intensive care unit, Medication Safety, reporting system