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Quality indicators for safe medication preparation and administration: a systematic review.

Smeulers M, Verweij L, Maaskant JM, de Boer M, Krediet CT, Nieveen van Dijkum EJ, Vermeulen H - PLoS ONE (2015)

Bottom Line: The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration.A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death).Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, the Netherlands.

ABSTRACT

Background: One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used.

Objectives: The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration.

Methods: MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form.

Results: The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights.

Conclusion: Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators.

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Flowchart of the literature search.The five included studies were published between 1995 and 2010 (Table 1). None of the studies had undertaken quality indicator development specifically for the nursing process of medication preparation and administration. Two studies (Cheng et al. and Nigam et al.) originated from Canada, and both aimed to develop quality indicators for medication safety [18, 19]. The Australian NSW TAG study was commissioned by the Department of Health, which used the data to publish a manual of medication safety indicators for hospitals [20]. This study was not listed as a scientific study; it was found through the reference search. The McLoughlin et al. study had a wider scope and was undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. It involved several countries (Australia, Canada, the EU, Portugal, Spain and the United States) [21]. The QRC Advisor study was a study by the American Nurses Association that aimed to develop quality indicators for safety and quality of nursing care [22].
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pone.0122695.g001: Flowchart of the literature search.The five included studies were published between 1995 and 2010 (Table 1). None of the studies had undertaken quality indicator development specifically for the nursing process of medication preparation and administration. Two studies (Cheng et al. and Nigam et al.) originated from Canada, and both aimed to develop quality indicators for medication safety [18, 19]. The Australian NSW TAG study was commissioned by the Department of Health, which used the data to publish a manual of medication safety indicators for hospitals [20]. This study was not listed as a scientific study; it was found through the reference search. The McLoughlin et al. study had a wider scope and was undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. It involved several countries (Australia, Canada, the EU, Portugal, Spain and the United States) [21]. The QRC Advisor study was a study by the American Nurses Association that aimed to develop quality indicators for safety and quality of nursing care [22].

Mentions: The electronic search identified 1682 potentially relevant studies. Based on their title and abstract, 63 studies were reviewed in detail. Four studies met the inclusion criteria. The main reason for excluding studies was the inability to meet the methodological inclusion criteria for a combined literature search and expert panel opinion. Checking the references of the included studies yielded one additional study, resulting in a total amount of five included studies (Fig 1 and S5 Appendix). The grey literature search did not result in any additional studies.


Quality indicators for safe medication preparation and administration: a systematic review.

Smeulers M, Verweij L, Maaskant JM, de Boer M, Krediet CT, Nieveen van Dijkum EJ, Vermeulen H - PLoS ONE (2015)

Flowchart of the literature search.The five included studies were published between 1995 and 2010 (Table 1). None of the studies had undertaken quality indicator development specifically for the nursing process of medication preparation and administration. Two studies (Cheng et al. and Nigam et al.) originated from Canada, and both aimed to develop quality indicators for medication safety [18, 19]. The Australian NSW TAG study was commissioned by the Department of Health, which used the data to publish a manual of medication safety indicators for hospitals [20]. This study was not listed as a scientific study; it was found through the reference search. The McLoughlin et al. study had a wider scope and was undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. It involved several countries (Australia, Canada, the EU, Portugal, Spain and the United States) [21]. The QRC Advisor study was a study by the American Nurses Association that aimed to develop quality indicators for safety and quality of nursing care [22].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401721&req=5

pone.0122695.g001: Flowchart of the literature search.The five included studies were published between 1995 and 2010 (Table 1). None of the studies had undertaken quality indicator development specifically for the nursing process of medication preparation and administration. Two studies (Cheng et al. and Nigam et al.) originated from Canada, and both aimed to develop quality indicators for medication safety [18, 19]. The Australian NSW TAG study was commissioned by the Department of Health, which used the data to publish a manual of medication safety indicators for hospitals [20]. This study was not listed as a scientific study; it was found through the reference search. The McLoughlin et al. study had a wider scope and was undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. It involved several countries (Australia, Canada, the EU, Portugal, Spain and the United States) [21]. The QRC Advisor study was a study by the American Nurses Association that aimed to develop quality indicators for safety and quality of nursing care [22].
Mentions: The electronic search identified 1682 potentially relevant studies. Based on their title and abstract, 63 studies were reviewed in detail. Four studies met the inclusion criteria. The main reason for excluding studies was the inability to meet the methodological inclusion criteria for a combined literature search and expert panel opinion. Checking the references of the included studies yielded one additional study, resulting in a total amount of five included studies (Fig 1 and S5 Appendix). The grey literature search did not result in any additional studies.

Bottom Line: The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration.A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death).Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, the Netherlands.

ABSTRACT

Background: One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used.

Objectives: The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration.

Methods: MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form.

Results: The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights.

Conclusion: Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators.

Show MeSH