Sunday, June 6, 2010

Drug Errors Peak in July When New Docs Start

Drug Errors Peak in July When New Docs Start:"Are you waiting till Summer to have that operation? Keep this article in mind. Make sure you ask how many times a doctor has performed your operation. You do not want to be their first patient out of Medical School, trust me.
http://www.businessweek.com/lifestyle/content/healthday/639789.html#:

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Medication Errors, Drug Administration & Support, http://www.nursefriendly.com/mederror Follow us on:
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Brilliant Communication or Chicken Scratch? How to Read a Doctor's Prescription, Ask Your Pharmacist!:"Q. What does all that doctor's scribble on my prescription mean? Is there a trick to help me read prescriptions? A. Just like the English speak English, French speak French and the Vietnamese speak Vietnamese, doctors, nurses and pharmacists speak the language of medicine. It takes years of training to understand what might be spoken amongst health care professionals in your local hospital or the dense pages of information written in your own medical chart. Your prescription is an extension of this medical terminology. It contains key information and directions regarding your medication including the name, the dose, how to take it, when to take it, how frequently it should be ingested, and when the medication should be stopped, if it is to be taken for a definite duration."
http://www.askyourpharmacist.ca/how_to_read_prescriptions.html

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Computerized Order Entry Results in More Timely and Efficient Care, Cincinnati Children's Hospital Medical Center:""The COE system makes illegible physician handwriting a thing of the past," says Dr. Jacobs. "It also is seamlessly integrated with a clinical documentation system. This system documents things nurses used to document on multiple paper forms, such as vital signs, allergies, heights and weights. And, it includes an electronic medication administration record, formerly transcribed onto a piece of paper by a health unit coordinator and/or a nurse but now seamlessly integrated into the informatics system." Clinical documentation is essentially electronic charting and supports the COE system by providing patient data such as vital signs, weights and patient assessment information for use in the ordering process. It eliminates safety issues, such as misinterpretation of orders and transcription errors, and it gets rid of redundant charting, which is an inefficient use of a nurse's time."
Jim Feuer, 513-636-4656, jim.feuer@cchmc.org
Cincinnati Children's Hospital Medical Center
3333 Burnet Avenue, Cincinnati, Ohio 45229-3039
513-636-4200 | 1-800-344-2462 | TTY: 513-636-4900
http://www.cincinnatichildrens.org/about/news/release/2003/1-coe.htm

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Death By Handwriting, By Maureen Glabman, Trustee Magazine :"Most Americans don't receive any formal handwriting instruction beyond the third grade, so how we learned to write then is more or less what we are stuck with for the rest of our lives. It's a worn joke that when someone writes poorly, we tell him he could be a doctor. But a medical error due to misinterpretation of illegible writing is no laughing matter--and for physicians it is a major threat to patient safety. The Joint Commission does not know precisely how often hospitals are reproached for handwriting deficiencies, but the problem is believed to be substantial. "The Joint Commission almost always finds instances where handwriting is of poor quality," says Peter Angood, M.D., JCAHO vice president and chief patient safety officer. The standard that encompasses handwriting legibility also includes stipulations that medical records be dated, that patients be identified and that diagnoses are supported, among other requirements, so it is difficult to sort out individual deficiencies."
http://www.trusteemag.com/trusteemag_app/jsp/articledisplay.jsp?dcrpath=TRUSTEEMAG/PubsNewsArticleGen/data/2005/0510TRU_FEA_Handwriting

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Doctor, is your writing legible? Animesh Jain, Prateek Rastogi, Indian Journal of Medical Ethics:"Today, computers are used in every field of work including medicine. Despite the computer revolution, however, a great deal of information in clinical records in hospitals continues to be handwritten. The doctor may understand what he/she has written, but difficulties arise when other parties are involved. The handwriting of healthcare professionals in general and doctors in particular has been known to be illegible and difficult to decipher (1). In India, as in most other parts of the world, it is generally accepted that doctors have handwriting which needs some skill to decipher. Yet the importance of a doctor`s handwriting cannot be overemphasised. Pharmacists and nurses have to read the physician`s prescription to dispense and administer the correct medication to patients. Patients need to understand the prescription to take proper and timely treatment. In one study, 117 case notes were examined and 18 (15%) were so illegible that the meaning was unclear (1). Another study suggests that doctors, even when asked to be as neat as possible, produce handwriting that is worse than that of other professionals (2). This provides supportive evidence for the commonly held belief that the legibility of doctors` handwriting is unusually poor."
Department of Community Medicine, Kasturba Medical College
Mangalore 575 001 INDIA
email: animesh_j@yahoo.com
Department of Forensic Medicine and Toxicology,
Kasturba Medical College, Mangalore 575 001 INDIA
http://www.issuesinmedicalethics.org/171co42

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Electronic Prescriptions Save Lives and Money, MichiganToday.net:"To combat growing quality and safety concerns, a bi-partisan coalition led by Debbie Stabenow, U.S. Senator (Michigan) is trying to pass legislation aimed at expediting the use of electronic prescribing. “E-prescribing” is when a physician uses a computer or hand-held computing device to electronically generate and send a prescription to a pharmacist's computer. The benefits of this technology include reducing potentially harmful drug interactions by alerting physicians of possible risks, eliminating illegible physician hand-written prescriptions and cutting patient wait time at the pharmacy. Less paperwork and more information for the physician equal more convenience and lower cost for the patient."
MichiganToday.net
P. O. Box 700112
Plymouth,, MI 48170
(734) 223-9645
http://www.michigantoday.net/living.electronicprescriptions.html

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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The handwriting is on the wall for nation's doctors. Penmanship classes helping to make prescriptions legible:"He's a veteran physician who works as a trauma surgeon. Just don't ask Dr. Sheldon Brotman to write a legible prescription. That's why he's here, sitting in a handwriting class at Atlantic City Medical Center, learning how to hold his pen, position his paper and put a sharp angle on his "z" so it doesn't look like an "s." "My signature is always a problem down at the pharmacy," Brotman said."
http://www.seattlepi.com/national/docs05.shtml

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Illegible handwriting in medical records, F Javier Rodríguez-Vera MD:"In clinical records many items are handwritten and difficult to read. We examined clinical histories in a representative sample of case notes from a Spanish general hospital. Two independent observers assigned legibility scores, and a third adjudicated in case of disagreement. Defects of legibility such that the whole was unclear were present in 18 (15%) of 117 reports, and were particularly frequent in records from surgical departments."
http://jrsm.rsmjournals.com/cgi/content/abstract/95/11/545

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Implementing a Legible Handwriting Policy, By Lewis Zulick, MD, MMM, FACS and Maura Farmer, American College of Physician Executives:"Legibility of chart notations and physician orders has become a topic of increasing concern since the health care industry began its prolonged introspection regarding patient safety first prompted by the Institute of Medicine report “To Err is Human” in 2000. Our hospital set out to create a medical staff policy to address this problem. Previously, the frequent illegibility of physician handwriting had been considered an unavoidable fact of life and even a source of wry amusement. There is an increasing realization that the poor communication that results from illegible chart entries is not an acceptable standard for the profession. As with many traditional practices viewed from a fresh perspective, it appears incredible that the present standard was ever considered acceptable. Still, there is a sense that illegible physician handwriting will be difficult to eliminate because of ingrained work habits and a lack of central authority with which to address the problem."
The American College of Physician Executives
400 N. Ashley Drive
Suite 400
Tampa, Fl 33602
Toll Free Phone Number: 800-562-8088
Outside the U.S. 813-287-2000
Fax: 813-287-8993
For general inquiries, please email: acpe@acpe.org
http://www.acpe.org/Publications/LeadingEdge/2006/Winter/cmu.aspx

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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In the long run, penmanship classes for doctors won't do much for patient safety, Institute for Safe Medication Practices (ISMP):"With the nation's attention now focused on patient safety issues, television and print journalists frequently cover stories about medical errors. Often, medication errors caused by poor physician handwriting are a common theme. While jokes and cartoons still flourish about illegible prescriptions, the public is personally familiar with this problem, and it is no longer considered a joking matter. Recently, national television networks and wire services have reported a number of efforts that are underway at hospitals across the country to bring doctors back to the classroom for courses in basic penmanship. While we applaud hospitals that seek to improve handwriting through these courses, we fear that such actions will achieve only marginal improvement at first and even less sustained improvement over time."
Institute for Safe Medication Practices (ISMP)
1800 Byberry Rd., Suite 810 Huntingdon Valley, Pa. 19006
Voice: 215.947.7797 Fax: 215.914.1492
E-Mail: ismpinfo@ismp.org
http://www.ismp.org/newsletters/acutecare/articles/20010110.asp

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Nature and Prevalence of Errors in Patient Care, January 18, 2005::"A Penn School of Nursing study provides the first detailed description of the nature and prevalence of errors by hospital staff nurses. During a 28-day period, 393 registered nurses kept a detailed journal of their errors and prevented errors, referred to as near-errors. Thirty percent of the nurses reported at least one error during the 28-day period, and 33 percent reported a near-error. Although the majority of errors and near-errors were medication-related, the nurses also reported a number of procedural, transcription and charting errors. The findings were presented in the November issue of the journal Applied Nursing Research and are derived from a previous study that examined staff nurse fatigue and patient safety."
http://www.upenn.edu/almanac/volumes/v51/n17/rr.html#patient

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Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety, Journal of Nursing Care Quality:"This study describes nurse perceptions about medication errors. Findings reveal that there are differences in the perceptions of nurses about the causes and reporting of medication errors. Causes include illegible physician handwriting and distracted, tired, and exhausted nurses. Only 45.6% of the 983 nurses believed that all drug errors are reported, and reasons for not reporting include fear of manager and peer reactions. The study findings can be used in programs designed to promote medication error recognition and reduce or eliminate barriers to reporting."
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=514523

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Physicians Barred From Cursive Writing For RX, By Stephen A. Frew JD, Medlaw.com:"In a move that caught physicians and pharmacists off-guard, a new Washington state law went into effect this month that requires prescriptions to be printed, typed or electronically entered in order to be filed and filled. The law bans cursive writing."
http://www.medlaw.com/healthlaw/MEDMAL/physicians-barred-from-cu.shtml

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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What can we do about illegible physician handwriting? HCPro, Inc.:"As part of our ongoing record review, we are monitoring legibility of handwritten entries in medical records. What would be the appropriate process to follow when addressing legibility of a physician's handwriting? I would like to have some options for corrective action when I approach the medical staff with this issue."
http://www.hcpro.com/CCP-31725-862/What-can-we-do-about-illegible-physician-handwriting-Do-we-have-to-give-our-privacy-notice-to-all-of-our-existing-patients-Payperview-article-The-inside-scoop-How-the-OIGs-pharma-guidance-affects-providers.html

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Why is handwriting important? Prescription for Safety, American College of Physicians:"Physicians' handwriting is a source of endless jokes, but illegible orders are no laughing matter. Illegible handwriting on prescriptions takes extra time to interpret, and pharmacist callbacks result in lost time to the practitioner. Tragically, illegible handwriting is a common cause of medical error and has led to patient injury and death. According to a 1997 American Medical Association report, errors related to misread prescriptions were the second most common and expensive malpractice claim over a seven-year period.2"
http://www.acponline.org/running_practice/patient_care/safety/faq.htm

Illegible Handwriting, Physician's Penmanship, Direct Patient Care, http://www.nursefriendly.com/illegible

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Edwardsville nursing home fined $50,000 in patient death, Illinois:"An Edwardsville nursing home has been fined $50,000 for improperly giving pain medication to a patient who died. Rosewood Care Center, a 120-bed nursing home on Center Grove Road, was fined in connection with its treatment of an 86-year-old patient who was found dead in August a few hours after the patient received OxyContin, a powerful pain reliever. That dose was given four hours after a previous dose of OxyContin was given to her at a hospital emergency room."
http://www.chicagonursinghomeabuselawyerblog.com/2010/02/chicago_illinois_nursing_home.html

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December 13, 2004: Focus on Learning, Not Blame. New error-reporting system in Minnesota works to ensure mistakes don't happen again:"Mistakes are always easier to correct when there is a full understanding of the process involved. Outcomes improve and methods become more efficient. When lives literally hang in the balance of methods of care, education becomes a life-and-death matter. A new error- and events-reporting system in Minnesota is forcing hospitals to take a hard look at serious mistakes in the health care system and how to fix them. The St. Paul-based Minnesota Nurses Association (MNA) supports the legislation, which was signed into law effective July 1, 2003. Full implementation of the law began December 6."
http://www.nurseweek.com/news/Features/04-12/ReportingSystems.asp

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Common Medication Errors, Medical Legal Consultants of Colorado:"The Institute of Medicine brought national attention to the problem of mistakes involving medications. Medication errors may occur in the process of prescribing, dispensing or administering a drug and is considered an error whether there are adverse consequences or not. Recently, a report from the U.S. Pharmacopeia (USP)* showed that the three most frequently reported types of medication errors were:"
Medical Legal Consultants of Colorado:
31 N. Tejon St., Suite 300, Colorado Springs, Colorado 80903
719-444-0544 • 888-594-6973 • Fax 719-635-9391
http://www.medical-legal-consultants.com/newsletter/feb01.htm#3

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Medication Administration by Unlicensed Assistive Personnel:

Hello Everyone,

This is a supplement to our Nursefriendly Notes Newsletter:

In several states in the US, it is now commonplace for Unlicensed Assistive Personnel with minimal training (in some states as little as 48 hour courses) being allowed to pass meds.

As stated, it is usually under the "supervision" and responsibility of a licensed nurse.

The following are position statements and actual laws on the books.

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Illinois: INA Testifies on Proposed Rules for Medication Administration in DD Group Homes:"Emergency Rules provides for a registered nurse to monitor, direct, guide and evaluate the outcomes of an activity or task, and to maintain accountability for tasks and responsibilities delegated to qualified assistive personnel. This rule is consistent with the 1997 Illinois Nursing and Advanced Practice Nursing Act and Rules."
http://findarticles.com/p/articles/mi_qa3932/is_200001/ai_n8882366/

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Massachusetts: Nursing Practice Related to Medication Administration by Certified Program Staff in Community Residences - Departments of Mental Health and Retardation:"Nurses deemed qualified by the Departments of Mental Health (DMH) or Mental Retardation (DMR) to teach the established program of instruction for medication administration may instruct unlicensed program staff in the didactic and practical components of the program leading to certification in medication administration."
http://webcache.googleusercontent.com/search?q=cache:CNmnVgd8vJAJ:www.mass.gov/Eeohhs2/docs/dmr/map_trainer_professional_oversight.rtf+%22Nursing+Practice+Related+to+Medication+Administration+by+Certified+Program+Staff%22&cd=1&hl=en&ct=clnk&gl=us

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Minnesota Rules, Table of Chapters, ADMINISTRATION OF MEDICATIONS BY UNLICENSED PERSONNEL:"Subpart 1. Authorization. The director of nursing services may delegate medication administration to unlicensed personnel according to Minnesota Statutes, sections 148.171, subdivision 15, and 148.262, subdivision 7."
https://www.revisor.mn.gov/rules/?id=4658.1360

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New Jersey State Nurses Association: Medication Administration By Unlicensed Personnel:"Unlicensed personnel must receive education, which is developed, taught and evaluated by a registered professional nurse. It is the responsibility of the registered professional nurse to verify the preparation of the unlicensed personnel to perform the administration or assistance with self-administration of medication. NJSNA encourages the Board of Nursing to approve curriculum preparation and evaluation methods involved in medication administration by unlicensed personnel. The registered nurse should understand the delegatory clause of the Nurse Practice Act and her/his role and responsibility of supervision of the unlicensed assistive personnel."
New Jersey State Nurses Association
1479 Pennington Road Trenton, New Jersey 08618
Phone: 609-883-5335; Fax: 609-883-5343
http://www.njsna.org/displaycommon.cfm?an=1&subarticlenbr=83

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North Carolina: Authorization to administer Over-the-Counter Drugs, Requirements for Unlicensed Persons:"According to the NC Board of Nursing, trained, unlicensed persons may administer medications to clients in settings where the client’s health care needs are incidental (secondary) to the personal care required. Such settings include community DDA, ICF-MR, and Willie M. group homes, and specialized units in DMHDDSAS inpatient facilities (e.g., Willie M. Unit at the Special Care Center). Training should be provided by a registered nurse, pharmacist or other legally qualified person who is privileged to prepare and administer medications."
http://www.dhhs.state.nc.us/mhddsas/pharm/administ.htm#Unlicensed%20Persons

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North Dakota, Medication Admin by Medication Assistant:"Medication administration is a nursing intervention. The implementation of a medication assistant program became effective in September 1994 and had extensive revisions in 1999. The initial adoption of the rules provided a framework for nurses, medication assistants, employers, and the public to identify the competencies expected of the medication assistant that lead to registry status. An explanation of the subject matter of the present rules follows."
http://www.aama-ntl.org/CMAToday/articles/publicaffairs/details.aspx?ArticleID=304

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West Virginia, Medication Administration By Unlicensed Personnel:"This legislative rule prescribes specific standards and procedures to provide for training, competency testing, and approval of unlicensed personnel for limited administration of medications in specified health care facilities. This rule must be read in conjunction with W. Va. Code §16-5O-1 et seq."
http://www.wvdhhr.org/ohflac/AMAP/64-60.aspx

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Tuesday 23rd November, 2004: Study examines nursing error frequency:"A study of work errors by 393 registered nurses released Monday shows 30 percent were aware of making at least one error in a 28-day period. A further 33 percent reported a near-error in the University of Pennsylvania School of Nursing study, in which nurses kept a detailed journal of errors and near-errors."
http://feeds.bignewsnetwork.com/?sid=a89ae4c26e80a11c

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November 15, 2000: Medication Administration In Nursing Homes:"You asked about other states' laws, regulations, or policies permitting people who are not licensed as registered or practical nurses to give medicines to nursing home residents. This is an update of OLR Report 2000-R-0123, which describes nine states' (Indiana, Iowa, Kansas, Maryland, Minnesota, Nebraska, Rhode Island, South Dakota, and Texas) rules."
http://www.cga.ct.gov/2000/rpt/olr/htm/2000-r-0705.htm

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Medication Administration In Nursing Homes:"At least nine states (Indiana, Iowa, Kansas, Maryland, Minnesota, Nebraska, Rhode Island, South Dakota, and Texas) allow nurses' aides or other unlicensed personnel who receive extra training to administer medicines in nursing homes under the supervision of a doctor, nurse, or other health professional. They are often called "medication aides," "medication technicians," or "unlicensed assistive personnel." In a number of states, including Connecticut, such activities are allowed in state mental retardation or mental health facilities, but not in nursing homes serving the elderly. Others allow unlicensed personnel to assist less frail elderly people with self-administering their medicines in assisted living facilities or residential care homes, but not in nursing homes."
http://www.cga.ct.gov/2000/rpt/olr/htm/2000-r-0123.htm

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What Makes Something A Nursing Activity Or Task:"The boundaries between different groups of professionals, as well as between professionals and nonprofessionals, have blurred so much that an activity such as medication administration is now considered by legislators appropriate to be performed by registered nurses, licensed practical nurses, unlicensed assistive personnel, pharmacists, dialysis technicians, and the list goes on."
http://www.nursingworld.org/ojin/tpclg/leg_9.htm

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American Society of Consultant Pharmacists: Statement on Administration of Medications in Long-Term Care by Unlicensed Personnel:"The health care industry is having increasing difficulty attracting adequate numbers of licensed nursing personnel. As the number of older adults in the United States increases over the next ten to twenty years, this problem is expected to worsen. In fact, a general shortage of nurses in the United States is expected to occur in the next few years. Administration of medications in long-term care and other institutional settings has long been a duty performed by nurses. In the recent past, a number of states have changed their laws to permit administration of medications in long-term care settings by unlicensed personnel, or medication aides. However, the amount of training required, the scope of duties permitted, and the degree of supervision required vary considerably from state to state. Little or no research has been published on the quality or accuracy of medication administration by unlicensed personnel."
American Society of Consultant Pharmacists
1321 Duke Street Alexandria, VA. 22314-3563
(703) 739-1300 FAX: (703) 739-1321
http://www.ascp.com
e-mail: info@ascp.com http://www.ascp.com/resources/settings/assistedliving/medadmin.cfm

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Maine: Administration Of Medication In The School Setting:"This rule establishes the requirements for the safe administration of medication in each school administrative unit and approved private schools. This rule requires that all unlicensed school personnel who administer medications in a school setting receive training by the Department of Education or by a certified school nurse using curriculum approved by the Department."
http://www.maine.gov/education/edletrs/2005/ilet/05ilet029.htm

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Similar Drug Name List Helps Avoid Medication Errors:"A updated list of similar drug names that can help avoid medication errors has been released from the United States Pharmacopeia (USP) Practitioners' Reporting Network."
http://www2.nurses.com/content/news/article.asp?DocID={9A22D4E4-597D-11D3-9A5F-00A0C9C83AFB}&Bucket=Drug+Update

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24 February 2005: United Kingdom: Bungling nurse struck off:"A nurse has been struck off the register for risking patients' health after ignoring bosses' orders to keep away from the drip feeds. Maureen Zulu, 43, tried to put antibiotics through a patient's blood transfusion line while working at St Mary's Hospital in Paddington, in 2002. The Nursing and Midwifery Council (NMC) heard how staff caught Zulu as she was about to put the antibiotics in the wrong tube. When questioned she asked: "Where am I supposed to put it?"
http://www.hammersmithtimes.co.uk/content/hammersmith/times/news/story.aspx?brand=WMTOnline&category=news&tBrand=northlondon24&tCategory=newshmst&itemid=WeED24%20Feb%202005%2014%3A51%3A29%3A813

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