systematic review strategies to reduce medication errors ...€¦ · strategies to reduce...

Int J Evid Based Healthc 2006 4 2ndash41

copy 2006 Blackwell Publishing Asia Pty Ltd

Blackwell Publishing AsiaMelbourne AustraliaJBRInternational Journal of Evidence-Based Healthcare1744-1595copy 2006 The Authors Journal compilation copy 2006 The Joanna Briggs Institute 200641241Systematic ReviewStrategies to reduce medication errorsB Hodgkinson

et al

Correspondence Mr Brent Hodgkinson School of Population Health University of Queensland Public Health Building Brisbane Qld 4006 Australia Email bhodgkinsonuqeduau

S Y S T E M A T I C R E V I E W

Strategies to reduce medication errors with reference to older adults

Brent Hodgkinson BSc (Hons) MSc GradCertPH GradCertEcon(Health)1 Susan Koch RN BA DipProfStud PhD MN FRCNA FAAG2 Rhonda Nay RN PhD2 and Kim Nichols BSc(Hons) PhD DipEd3

1School of Population Health University of Queensland Brisbane Queensland 2Australian Centre for Evidence Based Aged Care La Trobe University Melbourne Victoria and 3School of Education University of Queensland Brisbane Queensland Australia

Abstract

Background In Australia around 59 of the general population uses prescription medi-cation with this number increasing to about 86 in those aged 65 and over and 83 of thepopulation over 85 using two or more medications simultaneously A recent report suggeststhat between 2 and 3 of all hospital admissions in Australia may be medication relatedwith older Australians at higher risk because of higher levels of medicine intake and increasedlikelihood of being admitted to hospital The most common medication errors encounteredin hospitals in Australia are prescriptionmedication ordering errors dispensing administra-tion and medication recording errors Contributing factors to these errors have largely notbeen reported in the hospital environment In the community inappropriate drugs prescrib-ing errors administration errors and inappropriate dose errors are most common

Objectives To present the best available evidence for strategies to prevent or reduce theincidence of medication errors associated with the prescribing dispensing and administra-tion of medicines in the older persons in the acute subacute and residential care settingswith specific attention to persons aged 65 years and over

Search strategy Bibliographic databases PubMed Embase Current contents TheCochrane Library and others were searched from 1986 to present along with existing healthtechnology websites The reference lists of included studies and reviews were searched forany additional literature

Selection criteria Systematic reviews randomised controlled trials and other researchmethods such as non-randomised controlled trials longitudinal studies cohort or casendashcontrol studies or descriptive studies that evaluate strategies to identify and managemedication incidents Those people who are involved in the prescribing dispensing oradministering of medication to the older persons (aged 65 years and older) in the acutesubacute or residential care settings were included Where these studies were limitedevidence available on the general patient population was used

Data collection and analysis Study design and quality were tabulated and relativerisks odds ratios mean differences and associated 95 confidence intervals were calcu-

Strategies to reduce medication errors 3


lated from individual comparative studies containing count data where possible Allother data were presented in a narrative summary

Results Strategies that have some evidence for reducing medication incidents arebull computerised physician ordering entry systems combined with clinical decision

support systemsbull individual medication supply systems when compared with other dispensing

systems such as ward stock approachesbull use of clinical pharmacists in the inpatient settingbull checking of medication orders by two nurses before dispensing medicationbull a Medication Administration Review and Safety committee andbull providing bedside glucose monitors and educating nurses on importance of

timely insulin administrationIn general the evidence for the effectiveness of intervention strategies to reduce

the incidence of medication errors is weak and high-quality controlled trials areneeded in all areas of medication prescription and delivery

Key words intervention studies medication errors nursing prevention

Introduction

Background

In Australia around 59 of the general population usesprescription medication with this number increasing toabout 86 in those aged 65 and over and with 83 of thepopulation over 85 using two or more medicationssimultaneously1

A recent report suggests that between 2 and 3 of allhospital admissions in Australia may be medication related2

The Harvard Medical Practice study in the USA found thatin hospital patients disabled by some form of medicaltreatment 19 of recorded adverse events were related tomedications3

Older Australians have higher rates of medication incidentsbecause of higher levels of medicine intake and increasedlikelihood of being admitted to hospital (hospital statisticsbeing the main source of medication incident reporting)4

In the community setting it has been estimated that upto 400 000 adverse drug events may be managed in generalpractices each year in Australia4

The financial burden is staggering with one estimate put-ting the cost of preventable medication errors in the USAalone between $17 and $29 billion per year5 In Australiathe cost has been estimated at over $350 million annually2

What are the types and causes of medication errors

Studies examining the types and causes of medication errorsoccurring in older adults (ge65 years) are limited Howeverevidence is available on the general population and is taken

to be representative of those issues that would arise in thegeriatric setting Where specific reference to older adults isfound it is highlighted in this report

In a recent review by the Australian Council for Safety andQuality in Health Care the types of medication errors mostfrequently encountered in an Australian healthcare settingand their likely causes were presented4 The results of thisreport present the best data with a particular focus on Aus-tralia that is presently available and are summarised asfollows

Errors in hospital The most common errors related tomedication that are encountered in hospitals in Australia arebull prescriptionmedication ordering errorsbull dispensing errorsbull errors in administration of medicines andbull errors in the medication record

Table 1 Types of medication errors in general medical practice

Type of incident Rate per 100 incidents

Inappropriate drug 30Prescribing error 22Administration error 18Inappropriate dose 15Side-effect 13Allergic reaction 11Dispensing error 10Overdose 8System inadequacies 7Drug omitted or withheld 6

Source Australian Council for Safety and Quality in Health Care (2002 p 33)4

4 B Hodgkinson et al


Data from the Australian Incident Monitoring Systemshowed that most medication incidents occurring in hospitalwere categorised as omissions (gt25) overdoses (20)wrong medicines (10) drug of addiction discrepancy(lt5) incorrect labelling (lt5) or an adverse drug reaction(lt5) However little is known as to why medication errorsoccur in Australian hospitals Failure to read or misreadingthe chart and a lack of robust systems for prescribing andordering were suggested as the reasons for most of theseerrors4

Errors can occur at any step in the medication process Arecent Australian review has attempted to describe the typesof medication errors at each stage in the process which issummarised as follows4

Prescriptionmedication ordering errors Medicationerrors occur during the prescribing or interpretationtrans-lation of orders from one document to another

Based on limited Australian data on prescription errorsapproximately 2 of all prescriptions have the potential tocause an adverse event with the most common causes beingthe wrong or ambiguous dose missing dose or the direc-tions for use were unclear or absent This can be comparedwith other countries in which the medication error rateshave been reported to be between 2 and 76

Dispensing errors Dispensing errors occurring within thehospital pharmacy have not been comprehensively studiedError rates have been reported to range from 008 to 08of all items dispensed However the causes and the potentialfor adverse events have not been reported4

Errors in administration of medicines These errors occurwhen different patient medication supply systems are used

When patients are given medicines from a common wardsupply error rates are between 15 and 20 comparedwith error rates of between 5 and 8 when individualpatient medicine supplies are provided4

Timing errors as high as 8 of administered doses havebeen shown to occur as a result of a patient being providedwith a medicine at least 1 h before or 1 h after the scheduledtime These errors occur most likely because of time con-straints and are unlikely to cause harm in the majority ofcases4

Errors in the medication record A common error is thelack of documentation of previous adverse drug reactions andallergies Australian studies have found that previously knownadverse drug reactions were not recorded in 75ndash77 of casesevaluated In another study 8 of cases had omissions ofknown allergic reactions in patient records The causes andpotential for adverse drug events were not described4

Errors in the community setting The review describedmedication incidents in general practice and communitypharmacies4 General practitioners (GPs) and pharmacistswere asked to provide explanation as to why the medicationincidents occurred

General practice The types of medication incidents mostcommonly reported are described in Table 1 The factorscontributing to these errors are summarised in Table 2

Pharmacies The most common types of dispensing errorsreported by pharmacists are the selection of the incorrectstrength incorrect product or misinterpretation of a pre-scription The major reason for selecting the incorrectstrength or product has been described as the result of lsquolookalikersquo or lsquosound alikersquo error

The report4 describes an Australian survey of 209 commu-nity pharmacists where the major factors cited for contrib-uting to dispensing errors were cited asbull high prescription volumebull overworkbull fatiguebull interruptions to dispensing andbull lsquolook alike sound alikersquo drug names

Other factors that contribute to medication errors Thereview also described other possible factors that could con-tribute to medication error4

Inadequate continuity of care Medication histories uponadmission or discharge from hospital are often incompleteStudies reviewing discharge prescriptions for patients foundthat 15 of medications intended to be continued were

Table 2 Factors contributing to incidents in general practice

Contributing factor Rate per100 incidents

Poor communication between patient and health professionals

23

Action of others (not general practitioner or patient)

23

Error of judgement 22Poor communication between health professionals 19Patient consulted other medical officer 15Failure to recognise signs and symptoms 15Patientrsquos history not adequately reviewed 13Omission of checking procedure 10General practitioner tired rushed or running late 10Patient misunderstood their problem andor

treatment10

Inadequate patient assessment 10

No correlation between these contributing factors and the resulting incident (Table 1) was madeSource Australian Council for Safety and Quality in Health Care (2002 p 33)4



omitted at discharge or that at least one medicine on aver-age was omitted from the discharge prescription At admis-sion one study found that on average one medicine was notdocumented on the medication history for every twopatients

In one survey of 106 GPs regarding the type of informa-tion they received from hospital about their patients nonotification was provided to the GPs in over 50 of casesBecause of a change in patient medications by the hospitalin 87 of cases the patientrsquos medicine at discharge wasdifferent from what the GP understood before admission in72 of cases

Finally in a regional hospital in Queensland of the referralmedical records of 100 oncology patients 72 had thepotential for one or more errors in the patientrsquos medicationThe most common reasons for these errors were described asbull insufficient documentation to allow dosages to be

confirmedbull handwritten or illegible medication orders andbull lack of instruction about the length of time between

cycles of chemotherapy

Multiple healthcare providers In one study of 204 peo-ple 48 had medicines prescribed by more than one doc-tor and 28 had medicines dispensed by more than onepharmacist The effect on medication error and adverse drugevents has not been studied

Keeping unnecessary medications This involves keepingmedications that are no longer in use or have passed theirexpiry date In one small study where pharmacists madehome visits to assist in medication management 21 ofpeople were keeping medicines that were no longer in useand 20 were keeping expired medications The effect onmedication error and adverse drug events has not beenstudied

Generic namestrade names One study found that 29of consumers did not understand the difference betweenthe generic and trade name of a medication Again theeffect on medication error and adverse drug events has notbeen studied

Understanding the label In a single survey 84 lsquoolderconsumersrsquo incorrectly interpreted the instruction to lsquotakeone tablet every 6 h 1 h before foodrsquo The effect on medi-cation error and adverse drug events has not been studied

As medication errors can occur at all stages in the medi-cation process from prescription by physicians to deliveryof medication to the patient by nurses and in any site inthe health system it is essential that interventions be tar-geted at all aspects of medication delivery4

Therefore it is vital that healthcare providers be aware ofthe current evidence in relation to effective interventions forreducing the incidence of medication errors This reviewattempts to summarise the best available evidence on theseresearch interventions highlighting where possible preven-tion in the aged care arena

Objectives

To present the best available evidence for strategies to pre-vent or reduce the incidence of medication errors associatedwith the prescribing dispensing and administration of med-icines in the older persons in the acute subacute and resi-dential care settings

The specific review question to be addressed is whatstrategiesinterventions are most effective in reducing theincidence of medication incidents (errors) in the acute sub-acute and residential care settings

Review method

An expert panel of 13 clinicians nurses pharmacists andother allied health professionals was established to guide thesystematic review process by defining the criteria for studyinclusion identification of key search terms and relevantdatabases and evaluating the clinical importance of theresulting evidence (Appendix 1)

Criteria for considering studies for this review

Types of studies

This review considered any systematic reviews or ran-domised controlled trials (RCTs) that evaluate strategies toreduce or prevent medication incidents (Appendices II andIII) However in the absence of any RCTs other researchmethods such as non-RCTs longitudinal studies cohort orcasendashcontrol studies or descriptive studies were used Qual-itative studies grounded theory and ethnographic studieswere included in a narrative summary Only studies writtenin the English language were included in the review For thepurposes of the review medication referred to medicationthat has been prescribed by a medical practitioner not over-the-counter or herbal or vitamin preparations

Types of participants

Those people who are involved in the prescribing dispens-ing or administering of medication to the older persons(aged 65 years and older) in the acute subacute or residen-tial care settings were included in the review namelybull registered nursesbull enrolled nurses (or equivalent eg licensed practical

nurses)



bull pharmacistsbull physiciansmedical practitioners (or equivalents) andbull personal care attendantsancillary staff (or equivalent)

In the absence of articles relating the older persons spe-cifically to medication incidents (errors) in the acute sub-acute or residential care settings articles were reviewed thatdid not specify the age of the clientpatient using the samecriteria as described previously

Types of intervention

All studies reviewing strategies to prevent medication inci-dents (errors) in the acute subacute and residential settingswere considered

Types of outcomes

The main outcome measure of interest to be considered wasthe number of medication errors or adverse drug events

after intervention (and before in studies without parallelcontrol groups) In the absence of primary outcome mea-sures studies with surrogate measures such as test scoresand number of distractions were also considered

Search strategy

The search terms in Table 3 were identified for a PubMedsearch (Appendix IV) Similar terms and strategies were usedfor the different bibliographic databases with the same text

Table 3 PubMed search strategy management of medicationerrors in older adults

Search category Search terms

MeSH Medication errors aged prescriptions drugTitle or abstract

termsMedication errors adverse event aged

elderly adults drugs medication

Figure 1 Schema of the stages of searching and inclusionexclusion of references for the review

Initial search and assessment for inclusi (based on title and abstract) 849 articles

56 articles retrieved and pearled for possible inclusionsSecond assessment for inclusion (based on full text) 6 additional articles identified and retrieved

Final inclusion20 studies 3 systematic reviews See Appendix II

Excluded citations (775 articles) Wrong study design Wrong outcome(s) Wrong comparator

Final exclusion 30 articles Wrong study type Wrong outcomesIdentified in systematic review8 other articles used in backgroundand one report describing types an causes of medication errors in Australia



words being used along with the relevant alternatives toMeSH (ie EmTree headings in EMBASE)

Bibliographic databases

bull PubMed (NLM) 1986ndashFebruary 2005bull Embase 1986ndashFebruary 2005bull CINAHL (SilverPlatter) 1986ndashFebruary 2005bull Current Contents 1993ndashFebruary 2005bull Cochrane Library 1986ndashFebruary 2005

bull Cochrane Database of Systematic Reviews (CDSR)bull Database of Abstracts of Reviews of Effectiveness

(DARE)bull The Cochrane Controlled Trials Register (CCTR)bull The Health Technology Assessment Database (HTA)bull NHS Economic Evaluation Database (NHS EED)

bull Science Citation Index Expandedbull ProceedingsFirst 1993ndashFebruary 2005bull Social Science Indexbull International Pharmaceuticals AbstractsHealth Technology Assessment (HTA) websites were alsosearched for relevant systematic reviews and studies (seeAppendix V)

Search phases

The initial search was through the aforementioned elec-tronic databases Articles for inclusion were firsts assessedfrom titles and abstracts only Articles identified as potentialinclusions were collected and assessed for inclusion basedon the full text The reference lists of all studies determinedto match the inclusion criteria for effectiveness or safetywere then pearled for any possible inclusions (Figure 1)

Methodological quality

The evidence presented in the selected studies was assessedand classified using the dimensions of evidence defined bythe National Health and Medical Research Council7

These dimensions (Table 4) consider important aspects ofthe evidence supporting a particular intervention and

include three main domains strength of the evidence sizeof the effect and relevance of the evidence The first domainis derived directly from the literature identified as informinga particular intervention The last two require expert clinicalinput as part of their determination

The three subdomains (level quality and statisticalprecision) are collectively a measure of the strength of theevidence

Level of evidence

Levels of evidence differ in terms of the hierarchy dependingon the type of research question being asked Studies assess-ing the effectiveness of interventions were assessed usingthe National Health and Medical Research Council levels ofevidence (Table 5)

Quality of evidence

The appraisal of systematic reviews was performed using achecklist developed by the National Health Service Centrefor Reviews and Dissemination8 This is a generic checklistthat allows for the appraisal of systematic reviews that incor-porate study designs other than RCTs (Appendix VI) A lsquoqual-ity scorersquo will be approximated from this checklist byattaching a point to each criterion that is met by the sys-tematic review

The appraisal of intervention studies was undertakenusing a checklist developed by the Joanna Briggs Institutefor Evidence Based Nursing and Midwifery

A checklist of the quality of observational studies devel-oped by the Joanna Briggs Institute for Evidence BasedNursing and Midwifery was also used where appropriate(Appendix VI)

Data collection and analysis

Study design and quality were tabulated and relative risksodds ratios mean differences and associated 95 confi-dence intervals were calculated from individual comparative

Table 4 Evidence dimensions

Type of evidence Definition

Strength of the evidenceLevel The study design used as an indicator of the degree to which bias has been eliminated by designQuality The methods used by investigators to minimise bias within a study designStatistical precision The P value or alternatively the precision of the estimate of the effect It reflects the degree of

certainty about the existence of a true effectSize of effect The distance of the study estimate from the lsquonullrsquo value and the inclusion of only clinically important

effects in the confidence intervalRelevance of evidence The usefulness of the evidence in clinical practice particularly the appropriateness of the outcome

measures used



studies containing count data where possible All other datawere presented in a narrative summary

Size of effect and relevance of evidence

For intervention studies rank scoring methods were used todetermine the clinically important benefit of the effect sizeas well as the clinical relevance of the outcome beingassessed7 A clinically important benefit will be set as a 20difference between the confidence limit closest to the mea-sure of no effect and the no effect line (Appendix VI)

Results

Are interventions effective at reducing medication errors in older persons

Are interventions that are designed to reduce medicationerrors during the ordering transcribing dispensing andadministering of prescription drugs to patients 65 years andover effective

Three systematic reviews68ndash10 one review4 and 20studies11ndash30 were identified that attempted to answer thisquestion One systematic review provided very generalinformation on the results of trials and therefore any stud-ies not identified in the other reviews that addressedinterventions to reduce medication errors were individu-ally identified and assessed10 and are included in thecount of the number of studies in the beginning of theparagraph

Before the discussion of the results of included studiesseveral points should be highlighted First the majority ofstudies did not direct interventions to patients in the olderpersons category (ge65 years) but rather to patients withintheir unit or hospital in general Because of the paucity ofresearch specifically addressing the older persons studiesthat involved general patients were included Second the

definition of a medication error varied and the severity ofmedication errors (ie life threatening vs minor) was notalways reported

Computerised systems

Analyses of medication errors have revealed that targetingerror prevention strategies at procedures and not individualsis likely to be more effective6 The following discussionaddresses the use of computer-based interventions at somephase of the prescribing to administration pathway toreduce medication errors

Computerised physician ordering entry and clinical decisionsupport systems Systems such as computerised physicianordering entry (CPOE) and clinical decision support systems(CDSS) were designed to target stages of ordering andadministration and dispensing stages respectively

CPOE is described as a computer-based system whereby thephysician writes all orders online Within this system the physi-cian is provided with a menu of medications available from theformulary displayed with the default doses and a list of thepotential range of doses The system attempts to improve leg-ibility completeness and safety of orders

CDSS provides computerised advice on drug doses routesand frequencies CDSS can also perform drug allergy anddrugndashdrug interaction checks as well as prompt for corollaryorders (such as glucose levels after insulin has beenordered)

A systematic review of studies evaluating CPOE andCDSS in the reduction of adverse drug events and med-ication errors was identified9 Included study designsconsisted of RCTs non-RCTs and observational studieswith controls No patient group was specified Defini-tions of medication errors and adverse drug events asdefined in the systematic review are provided in the fol-lowing box

Table 5 Designations of levels of evidence for assessing intervention studies

Level of evidence Study design

I Evidence obtained from a systematic review of all relevant randomised controlled trialsII Evidence obtained from at least one properly designed randomised controlled trialIII-1 Evidence obtained from well-designed pseudo-randomised controlled trials (alternate allocation or some other

methods)III-2 Evidence obtained from comparative studies (including systematic reviews of such studies) with concurrent

controls and allocation not randomised cohort studies casendashcontrol studies or interrupted time series with a control group

III-3 Evidence obtained from comparative studies with historical control two or more single-arm studies or interrupted time series without a parallel control group

IV Evidence obtained from case series either post-test or pre-testpost-test

Modified from National Health and Medical Research Council (2000)7



Results were not combined in a meta-analysis butprovided as narrative summaries and are summarised asfollows

Medication errors and adverse events In two studies3132

significant reductions in non-intercepted serious medicationerrors (medication errors that either have the potential to oractually cause harm to a patient) of 55 and 86 wereidentified with one study showing a 17 decrease in adversedrug events however this was not significant

Other outcomes The remaining studies evaluated morespecific outcomes A single study reported a significantimprovement in the rate corollary orders using computer-ised reminders33 whereas another demonstrated animprovement in five prescribing practices34 and a third studyidentified a 13 and 24 decrease in inappropriate doseand frequency respectively of nephrotoxic drugs in patientswith renal insufficiency35

Three studies examined the effectiveness of computerisedadvice for antibiotic dosing on adverse drug events rates oftoxic drug levels or pathogen susceptibility36ndash38 In a prospec-tive before and after trial use of CDSS was associated witha 70 decrease in adverse drug events compared withcontrol whereas an RCT found a 17 greater pathogensusceptibility to the antibiotic drug regimen suggested byCDSS

In two RCTs evaluating CDSS guidance of theophyllinedosing results between studies were contradictory3940 Inthe larger of the two studies the treatment group displayedsignificantly lower rates of theophylline toxicity than thecontrol group The smaller study found no such differenceand is likely underpowered

Finally two studies examining CDSS guidance of antico-agulant dosing4142 found no significant differences in bleed-ing outcomes however given the small sample sizes it islikely that these studies are underpowered

In a recent controlled trial the effect of CPOE on medi-cation errors was evaluated in a university hospital setting30

After 8- and 11-month pre-intervention periods two generalmedicine units were provided with a CPOE system for afurther 7 and 4 months respectively During both pre- andpost-intervention periods the number of reported medica-tion errors was recorded Other hospital units that continued

Medication error errors in the process of ordering prescribingdispensing administering or monitoring medications

Potential adverse drug events medication errors with signifi-cant potential to harm a patient that may or may not actuallyreach a patient

to use handwritten physician orders were also monitored formedication errors and acted as control units

Medication error was defined as an error in the process ofordering dispensing or administering a medication regardlessof whether the potential for injury was present

Results showed that individually the units receiving CPOEsystems showed no significant change in the number ofreported medication errors before and after the implemen-tation of CPOE (Table 6) Pooled results of both unitsshowed an increase in the number of reported errors perdischarge During the same period control units displayeda reduction in reported errors per discharge Examination ofthe stage at which errors occurred showed an increase inreported error rates involving entry into the pharmacy com-puter system (pharmacy order processing category) on unitsusing CPOE but at no other stage

Anecdotal evidence suggests that implementation of theCPOE system in two US hospitals has reduced medicationerrors by 37 and more than 50 since inception43

Automated dispensing A systematic review identified fivestudies that examined the effectiveness of automated dis-pensing systems on reducing medication error rates6 Thisreview concluded that the available evidence was generallypoor and did not support the suggestion that automateddispensing systems improved outcomes

Not included in the Shojania review was a single studythat evaluated an automated point-of-use dose system(Medstation Rx) in a 26-bed adult general medicine unit28

Measurement of the incidence of dispensing error wasdetermined by comparing the technician error rate for filling

Medication errors and potential errors were voluntarily reportedon a form by nurses pharmacists and physicians to the Univer-sityrsquos Centre for Medication Safety Each error was investigatedand the severity of the error was rated by medication safety teammember on a scale from 0 to 6 (no actual incident occurredpotential error to incident resulted in death)

The system involves the location of controlled and secure med-icine storage units at nursing stations with patient medicationprofiles downloaded in the Pharmacy and transferred to theappropriate nursing unit

To dispense the desired medication the nurse selects thepatient of interest using the computer

Nurse selects desired medication and the storage unit releasesthe specific drawer and pocket containing the medication

Drug inventory required in each storage unit determinedthrough historical usage data



storage units 6 weeks before and 6 weeks after the introduc-tion of the Medstation Rx system

Results are described in Table 7 The use of an automatedpoint-of-use dose system significantly reduced the rate oferror in filling of dosage carts by technicians

Bedside terminal system One study examined the effec-tiveness of a portable bedside terminal documentation sys-tem on nursing practice and medication error rate14 Amedication error was defined as a variation from standardpractice and was to be recorded on an incidence report

Results are summarised in Table 8 The use of a bedsideterminal system had no effect on the reported medicationerror rate

In a 6-month study in three US hospitals in which full-function clinical information systems were moved from nurs-

Bedside terminal systems involve the use of touch screen hand-held portable terminals to enter and access data on individualpatients These portable computers communicate via radio fre-quency to a terminal server located on the unit

Table 6 Effect of computerised physician ordering entry (CPOE) on the number of medication errors

Study Level of evidence

Quality Population Measure ResultsErrors per discharge

Before After P

Spenceret al200530

III-3 QS 711 General medicine units Unit monitoredBefore and after study

Clinical importancenot estimable

Unit 1 with CPOE 0079 0092 NSUnit 2 with CPOE 006 0083 NS

R not estimable Pooled CPOE 0068 0088 0011Control units 0133 0079 lt0001Point of errordagger

Prescribing 0014 0008 NSUnit order processing 0014 0018 NSPharmacy order processing 0027 0053 lt001Dispensing 0003 0001 NSDelivery 0005 0002 NSAdministration 0019 0025 NSClinical monitoring 0001 0001 NS

daggerCPOE units onlyNS not significant P probability QS quality score R relevance

Table 7 Effectiveness of an automated point-of-use dose system

Study Level of evidence Quality Population Outcomes Results of doses dispensed

Ray et al199528

III-3Before and afterstudy

QS 611Clinical importance24

Patients on a 26-bedmedical unit

Technician errorrate for filling

089 before implementation061 after implementationP = 004

R 35 Relative difference (95 CI) 287 (36ndash538)

CI confidence interval P probability QS quality score R relevance

Table 8 Effectiveness of a bedside terminal system (BTS)

Study Level of evidence Quality Population Outcomes Results

Brownet al199514

III-3Before and after study

QS 711Clinical importancenot estimableR not estimable

Patients on a 35-bedsurgical unit

Medical error ratedagger

(40-h observation)071000 before BTS071000 after BTS

daggerTotal number of medical errors1000 doses dispensedQS quality score R relevance



ing stations to the patient bedside the authors claim areduction in medication errors of 3415

Computer-generated medication administration recordsOne before and after study (Level III-3) in a 584-bed hospitalconverted their handwritten 14-day medical administrationrecords (MAR) to a 24-h computer-generated MAR in anattempt to increase the accuracy of medication administra-tion avoid discrepancies between the pharmacy and thenursing staff and providing neat legible documentation11

The definition of a medication error was not defined in thisreport

The authors claim that a decrease in medication errors of18 was obtained after the first year of the new protocol

Computer alert system Five studies were identified in asystematic review that examined the use of computer alertsto prevent adverse drug events6 However the evidence forthe effectiveness of such systems is weak Only one studydemonstrated significant decreases in adverse drug eventsusing the alert system in a before and after study One otherstudy found no significant benefit of an alert system on theincidence of adverse drug events and three others only sawimprovements in the response times to obtaining laboratoryvalues A final study demonstrated a significant change inphysician behaviour and their modification of patient therapybased on the alerts and subsequent recommended actions

One other uncontrolled trial evaluated the incorporationof 37 adverse drug event alerts into the existing computerisedhospital information system of a 650-bed teaching hospital27

An example of an adverse drug event alert was the following

Primary prevention alertCardiac

Arrhythmia-digoxin ndash patient receiving digoxin and has aserum potassium level lt32 mmolL a serum magnesiumlevel lt075 mmolL or a digoxin level gt25 nmolL Rec-ommendation electrolyte replacement or digoxin dosereduction

The MAR is initially generated by order entry in the pharmacyThe computer-generated MAR is then reconciled by the 11 PM

to 7 AM shift nurses If a discrepancy exists a variance report isfilled out and any corrections are made by the pharmacy

Based on the patient information entered into the system aprescription could generate an adverse drug event alert that isprinted out and evaluated within the pharmacy If necessarythe alert is discussed with the appropriate nurse regardingthe patientrsquos clinical condition The pharmacist may contact theattending physician when the recommendations made by thealert seem appropriate

The study collected data on consecutive alerts for6 months after inception of the program A total of 9306non-obstetrical patients flowed through the system with1116 alerts recorded Of these 596 alerts (53) weredeemed to be true positives requiring action In 44 ofthese true positives (265596) the physician stated theywere unaware that a potentially dangerous clinical situationexisted

Bar codes A systematic review found one observationalstudy in which a hospital used hand-held scanners to iden-tify the patient nurse and the medication being adminis-tered6 The study found that the medication error rate in thehospital decreased from 017 before the system was insti-tuted to 005 after (P value not reported) Although thisresult was encouraging the use of the bar coding devicewas lsquoeasily and frequently circumventedrsquo bringing intoquestion the real contribution of the device to the overallerror rate decrease

In a recent ethnographic study nurse physician and phar-macist interaction with a newly instituted computerised sys-tem of bar code medication administration (BCMA) wasobserved in three veterans hospitals in the USA26 The aimof incorporating this technology was to reduce the inci-dence of adverse drug events

Five negative themes (side-effects) were identified in thisstudy1 nurse confusion over automated removal of medications

by the BCMA2 degraded coordination between the nursing staff and the

physicians3 nurses dropped activities to reduce workload during busy

periods4 increased prioritisation of monitored activities during

busy periods and5 decreased ability to deviate from routine sequences

One observer trained in ethnographic field observations con-ducted all observations before and after the implementation ofBCMA Observations occurred during all parts of day eveningand night shifts for a duration of between 1 and 7 h

BCMA involved the incorporation of software installed on alaptop permanently attached to the wheeled medication chart

Physicians were observed performing computerised orderentry followed by verification by the inpatient pharmacists

Nurses scanned bar coded wristbands on individual patientsand lsquoDUErsquo medications would be indicated for that patient Themedication bar code was then scanned and if it matched thedisplayed information then the system recorded the medicationas given and recorded the time If there was any discrepancy apop-up alert was displayed



It was suggested that these observed side-effects might lsquocre-ate new paths to adverse drug eventsrsquo

Therefore the study authors recommended that the soft-ware undergo design revisions and the hospitals institutebest practice training

Individual patient medication supply

Individual patient medication supply refers to the practiceof dispensing medications in a package that is ready toadminister to the patient One systematic review6 and twoAustralian studies4445 were identified

In the Australian studies4445 the use of individual patientsupply was found to significantly reduce the medicationerror rate compared with a ward stock system of medicationsupply with studies showing a decrease in the medicationerror rate from 154 (76494) to 48 (24502)45 ormissed medications from 57 (2233931 doses) to 41(1363287 doses) respectively44

In the systematic review6 results suggested that there is apositive impact of error reduction using an individual patientsupply system Five studies met the review inclusion criteria(four cross-sectional studies and one before and after study)The majority of these studies reported reductions in medica-tion errors using this system compared with alternative dis-pensing methods such as the ward stock approach primarilyin errors of omission and commission (erring in a task)

General conclusions computerised systems

Some evidence suggests thatCPOE combined with CDSS may be effective in reducing

medication errors in a general hospital population

Lower-level evidence for the effectiveness ofComputer-generated MARComputer adverse drug event detection and alerts

No evidence to suggest thatAutomated dosing systems reduce medication error incidence

Only reduce errors in filling of drawers by techniciansThe use of bedside terminal systems reduces medication error

incidenceBar coding patients or medications reduce medication error

incidence

Education and training

One study examined the effect of a compulsory medicationexamination on the rate of medication error in a 376-bedcommunity medical centre24

A medication error was defined as administeringbull the wrong medicationbull an extra dosebull a medication to the wrong patientbull a medication via the wrong routebull a medication gt30 min before or after the scheduled timebull a medication from an expired orderbull an intravenous fluid at the wrong rate by gt10bull or by omitting a medication

Results showed no difference in the incidence of medica-tion errors between the two time periods (Table 9)

One RCT evaluated the effectiveness of a 3-h educationalintervention compared with control (no education) on theability of nurses to calculate appropriate drug dosages12

Errors in calculating medication dosages and flow rates wereassumed to be a surrogate outcome for medication errors

General conclusions individual patient medication supplyIndividual medication supply systems have been shown to

reduce medication error rates compared with other dispensingsystems such as ward stock approaches

Unit dosages for each patient prepared in the pharmacy andadministered by registered nurses only

During Phase I nurses were required to pass an annualwritten medication examination consisting of 22 multiple-choice and 12 matching questions and 5 dosage calculationquestions

Phase II was instituted after policy was changed to eliminatethe annual examination as a requirement

The study followed the number of reported medication errorsover a 6-month period for each phase

Sixty-seven registered nurses were randomised into one of fourgroups (three intervention one control) Before intervention allparticipants completed a medication calculation test

Medication calculation test included

Table 9 Effectiveness of medication examination


Ludwig Beymeret al 199024



Community medical centrepatients

Incidence of medicationerrors over a period of6 months

With testing 142errors6 monthsWithout testing 137errors6 months

QS quality score R relevance



Results showed an increase in post-test scores for allgroups (Table 10) However analysis of covariance revealedno significant difference in post-test medication calculationtest scores between any of the experimental groups andcontrols (not shown)

Pharmacists

A systematic review summarised the results of one system-atic review and one RCT evaluating the role of clinical phar-macists in preventing adverse drug events in outpatientsand one systematic review and three other studies ofhospitalised patients6 In the inpatient setting this reviewidentified one prospective before and after study that dem-onstrated a statistically significant 66 decrease in prevent-able adverse drug events caused by medication ordering Ina retrospective before and after study the use of a clinicalpharmacist to check on new orders entering the pharmacyresulted in a 40ndash50 overall reduction in medication errorsIn a meta-analysis of primarily controlled observational stud-ies and non-randomised trials the use of a pharmacist tofollow up with patients resulted in patients being more likelyto have a therapeutic peak and trough and less likely to havea toxic peak and trough In the outpatient setting a system-

bull 10 items on calculating oral dosagesbull 4 items on intramuscular and subcutaneous dosagesbull 6 items involving calculation of intravenous medication dosages

and flow ratesIntervention groups then underwent 3-h training via one of1 self-study workbook2 computer-assisted instruction3 group classroom instructionNurses re-tested 4ndash5 months after intervention

General conclusions education and trainingThere is no evidence to suggest that education addressing

medication calculation or a yearly medication examination iseffective in reducing medication errors

atic review of over 16 000 outpatients determined that theuse of a pharmacist for consultation patient education andfollow-up resulted in improvements in outcomes for patientswith hypertension hypercholesterolaemia chronic heartfailure and diabetes Other outpatient studies determinedthat the use of pharmacist at discharge of geriatric patientsresulted in significantly fewer medication errors Finally inan RCT of 181 patients with heart failure patients in theintervention group received clinical pharmacist evaluationwhich included medication evaluation therapeutic recom-mendations to the attending physician patient educationand follow-up telemonitoring The control group receivedusual care This study found all-cause mortality and heartfailure events were significantly lower in the interventiongroup compared with the control group (4 vs 16P = 0005)

The involvement of a pharmacist at the point of prescrip-tion (ordering) of a drug by the physician was evaluated bythree further studies172246 In two studies the pharmacisteither made rounds with the medical team to provide imme-diate consultation22 or made rounds to each designated unitevery half hour to check on the accuracy of orders and toprovide consultation to the medical staff46 The results ofthese studies are summarised in Table 11

Both studies displayed a decrease in the number of med-ication errors per 1000 patient days with the improvedavailability of a pharmacist for consultation When the num-ber of errors per number of patients in each study groupwas examined the use of a pharmacist with the roundingteam showed significant improvement compared with therounding team only22

In a single study the process of reactive pharmacy inter-vention was evaluated in a single-arm study17 The objectivewas within the pharmacy to identify prescriptions that mayhave defects to prevent a possible impact on the patient (iean adverse event)

Table 10 Effectiveness of 3-h education interventions


Quality Population Outcomes Results

Pre-score Post-score

Mean SD Mean SD

Bayne andBindler199712

II QS 711Clinical importance 34

67 registerednurses

Medication test calculation scoresGroupControl (n = 18) 747 156 811 130

R not estimable Workbook (n = 18) 800 152 783 167CAI (n = 14) 782 97 821 119Classroom (n = 17) 703 175 788 171

CAI computer-assisted instruction QS quality score R relevance SD standard deviation



Prescription considered by pharmacistsIf prescription considered defective the pharmacist recorded

the followingbull relevant drug detailsbull summary and categorisation of the problembull coding of outcomesbull total time taken to initiate a response and resolve the

problembull grade of the prescribing doctorThe potential for medical harm graded separately by a singlephysician

The study found that approximately 3 of prescriptionswritten over the period of 28 days were flagged as faulty(Table 12) A high proportion of interventions were consid-ered justified (83) during review with 75 of interven-tions resulting in altered prescriptions

General conclusions pharmacistsThere is some evidence to suggest a role for clinical pharma-

cists in preventing adverse drug events in the inpatient setting

Table 11 Effect of pharmacist intervention on a number of medication errors

Study Level of evidence Quality Population Outcomes Results OR (95 CI)

Kucukarslanet al 200322

III-2Control study

QS 811Clinical importance

Experimental group86 patients from general medical unit

Preventable ADEdagger

Rounding team plus pharmacist

Rounding team only

14 Mean age No of errors1000 patient daysR 25 54 plusmn 19 years 57 265 NA

Control 79 patientsfrom general medical

No of errors per populationof study group ()

unit 286 (25) 979 (10) 019 (002 094)Mean age 56 plusmn 20 years

Shah et al199446


QS 611Clinical importance not estimableR not estimable

303-bed acute care facility

Reported medication incidents (per 1000 patient days)

Year before intervention303

Year afterintervention112

NA

daggerPreventable adverse drug event (ADE) defined as undesired reaction to medication that may have been prevented by appropriate drug selection or managementCI confidence interval NA not applicable OR odds ratio QS quality score R relevance

Table 12 Effect of reactive pharmacy intervention on improvement in prescription quality



Hawkeyet al199017

IVProspective uncontrolledstudy

NA All inpatients and outpatients in acute caremental illness or elderly

Interventions in prescribingprocess over a 28-day period alterations to prescription quality of the prescription

Intervention in 769 (29) of all prescriptions over 28 days639 (83) cases warranted intervention575 (75) of intervention resulted in altered prescriptionsmost notably because ofbull 280 wrong dosagebull 50 dosage not statedbull 48 over prolonged prescriptionIn 246 interventions (32)alteration resulted in anappreciable improvement in thequality of the prescription

NA not applicable



Nursing care models

Dedicated nurses Three studies examined the effectivenessof using dedicated nurses to dispense medication topatients141625

In one RCT 16 nurses from four nursing units of twohospitals were designated to be either medication nursesadministering medications to assigned patients or generalnurses providing care in the lsquousual mannerrsquo16

The results of the study are presented in Table 13 Thisstudy suggests that the use of dedicated medication nursesdoes not reduce the incidence of total medication andprocess-variation error rates

In a pilot project of before and after design (Level III-3)involving four units in a 950-bed hospital licensed practicalnurses were used as designated medication nurses13

The authors report that at the end of the trial the numberof reported medication errors was reduced to less than 50

Medication nurses participated in a medication safety program(1 day 8 h)

Nurses were observed during medication administration5 days a week (medication nurses for 2 days) for a period of12 weeks

Licensed practical nurses used as designated medication nursesfrom Monday to Friday on the day and evening shifts

Regular nursing staff provided medications on night shifts andweekends

The number of reported medication errors was evaluatedbefore trial and 3 months after inception

of pre-trial levels in three of the units whereas a fourthshowed a 300 increase (4 reports to 12) The cause of thisapparent aberration was explained as low reporting pre-trialand high staff turnover on this unit

In a recent study distractions during medication admin-istration were used as a surrogate measure for the potentialfor medication errors25 The study of registered nurses in amedical surgical unit during medication administrationlsquocyclesrsquo evaluated the use of two different interventions com-pared with customary medication administration proce-dures to reduce the number of distractions

Results of this study suggest that the use of a designatednurse for medication administration can lead to a reductionin the number of distractions that a nurse may encounterduring a medication administration cycle (Table 14)

Medication administration cycle encompasses commence-ment of administration of all assigned patient medicationsthrough to completion of documentation of all administeredmedications

Control 8 cycles where nurses used customary medicationadministration procedures (ie no designated nurse to delivermedications)

Focused protocol 8 cycles where a lsquospecial nursersquo designatedand staff asked not to interrupt or distract unless the interruptionis related to medications being administered

Medsafe protocol 8 cycles Nurse required to wear a spe-cial vest that identified nurse as performing medicationadministration cycle and lsquoDo Not Disturbrsquo Staff asked tointercept all phone calls or other distractions during thecycle

Distractions were measured using a medication administra-tion distraction observation sheet that was validated for thisstudy The number of distractions per cycle was measured

Table 13 Effectiveness of dedicated medication nurses


Quality Population Outcomes Results P

Medication nurses General nurses

Greengoldet al 200316

IIRCT

QS 811Clinical importancenot estimableR 25

16 nurses ge1 year ofacute care nursingInpatients in 4 units each of 1 academic community hospital and 1 university teaching hospital

Total error ratesdagger

Medication error ratesDagger

Process variation error ratessect

9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006

daggerTotal error rates = medication error rates + process variation error ratesDaggerMedication error = wrong drug dose route form rate dose preparation administration technique or omission of drugsectProcess variation error = not checking patient wristband borrowing medication dosing from unlabelled dispenser (eg unlabelled syringe)P probability QS quality score R relevance RCT randomised controlled trial



Checking (single vs double) Two Australian studies eval-uated the effectiveness of single versus double checking ofmedication by nurses for the reduction of medicationerrors2021

In a single cross-over controlled trial in three wards of ageriatric assessment and rehabilitation unit the effectivenessof two nurses versus one for reducing medication errors wasevaluated21

General conclusions dedicated nursesThere is no evidence to suggest that providing designated

nurses to dispense medication significantly reduces the inci-dence of medication errors

Use of the focused or Medsafe protocols in which nurses areidentified as lsquonot to be disturbedrsquo can reduce distractions tonurses during medication administration

Ward A selected for two-nurse medication administration for23 weeks

Ward B selected for one-nurse medication administration for23 weeks

Cross-over andWard A selected for one-nurse medication administration for

23 weeksWard B selected for two-nurse medication administration for

23 weeksWard C selected for two-nurse medication administration for

whole period of study (control)

A medication error was defined as administeringbull a medication to the wrong patientbull the wrong medicationbull an extra dosebull a medication to patient with a known allergy to that

medicationbull a medication from an expired orderbull or by omitting a medicationbull or the medication chart not signed

The results are summarised in Table 15 The point esti-mate illustrates that the use of two nurses to administermedications results in 30 lower odds of a medication errorbeing made compared with using one nurse

In a lower-quality study (Level of evidence III-3) theimpact on nursing practice and the number of reportedmedication errors were evaluated when standard practice ofdouble checking of medications before administration wasreplaced with a single-checking protocol20

Medication errors were identified by those reported on themedication incident records over a period of 7 months for eacharm of the study (ie double and single checking)

Only five reported medication incidents were identifiedover the 7-month period of standard practice (doublechecking) compared with four reported incidents during7 months of the single-checking protocol This differencewas not significant and was suggestive that single checkingwas as safe as double checking in this institution

Table 14 Effect of designated nurses on the number of distractions during medication cycles

Study Level ofevidence

Quality Population Study group Number of distraction during cycle

Mean(of 8 cycles)

SD Mean difference (95 CI) P

Pape200325

III-2 QS 711 Registerednurses

Control 605 129Controlstudy

Clinical importancenot estimableR 25

Focused protocol 225 85 38 (263 497)dagger lt0001Medsafe protocol 80 45 525 (421 629)dagger

145 (72 218)Daggerlt0001

0001

daggerResult compared with controlDaggerResult comparing Medsafe protocol with focused protocolCI confidence interval P probability QS quality score R relevance SD standard deviation

Table 15 Effect of one or two nurses for medication administration


2 nurses 1 nurse

Kruseet al199221

III-1Cross-over controlled trial

QS 811Clinical importance 25R 25

Geriatric patients

Errorsopportunities 9243 428 12040 275 07 (05 09)

CI confidence interval OR odds ratio QS quality score R relevance



Partners in patient care This nursing practice model aimsto extend nurse time by introducing the use of nursingpartners A single study that met inclusion criteria has exam-ined the lsquopartner in patient carersquo (PIPC) model on nursingunits of a Florida hospital19 A description of the model isprovided in a previous paper23

A medication error was determined by a single researcher asany incident that deviated from standard procedure and wasclearly the responsibility of nursing

Medication error rates ranged from 11000 to 41000patient days however the comparison data from each studygroup (control and pilot) were not provided The studyfound a significant difference in the medication error ratio(errorspatient day P = 0008)

Medication Administration Review and Safety A beforeand after study examined the effect of developing an inter-disciplinary Medication Administration Review and Safety(MARS) committee to reduce the number of medication

General conclusions nurse double checkingThere is some evidence to suggest that having two nurses

check medication orders before dispensing medication signifi-cantly reduces the incidence of medication errors

The PIPC nursing practice model involves five major compo-nents1 Participation in decision-making by staff (staff involved in the

design of the practice model)2 Use of a multiskilled technician in partnership with the nurse

as a patient care extender (nurse extender)3 Education provided on the change process (three for-

mal classes)4 Education on proper delegation of tasks to the nurse extender

(one class)5 Bedside computers installed as a point of care system (in each

care room and at the central nursing station)Pilot and control nursing units in a single hospital were randomlyselected

Control units used a total patient care nursing modelPilot units implemented the new PIPC modelMedication errors were derived from official incident reportsData were sampled at three time points before the interven-

tion 6 months into the implementation and at 1 year afterimplementation

General conclusions PIPCThere is limited evidence to suggest that introducing the PIPC

model significantly reduces the incidence of medication errors

administration documentation errors reported in a generalhospital29

A medication error was defined as mistake made during thetranscription preparation dispensation or distribution phasesof drug administration Specifically physician orders werereviewed for accuracy of transcription and timeliness of imple-mentation Documented medications were reviewed for accu-racy of right patient medication dose route and time Timelyadministration of Stat prn (as needed) and routine medicationswas also evaluated

Before the introduction of the MARS committee medica-tion administration documentation errors were reported afrequency of 0193 per patient day One year after introduc-tion of the MARS committee the rate of errors had dropped363 to 0123 per patient day

Process change One before and after study looked at theeffect a process change and education would have on theability of nurses to deliver insulin doses within a 60-min timeframe from point of blood glucose testing18 Before imple-mentation the procedure for ordering and administeringinsulin was not clearly defined or consistently followedThree nursing units were evaluated (a cardiac thoracic andneurosurgical ward an orthopaedic ward and a cardiac pro-gressive ward) for a period of 1 month before interventionand 6 months after implementation of the changes

Control period before implementation involved present practiceThe hospital utilised a clinical information computer systemalongside an automated medication administration system

MARS involved the introduction of an interdisciplinary com-mittee of staff nurses nurse managers pharmacists informationsystems analysts a risk manager and a nursing educator Thiscommittee reviewed all reported errors and then attempted toidentify potential causes of the errors If necessary medicationadministration policies were revised This information was thenshared with staff through a publication called a lsquoHot Spotsrsquobrief

A concurrent chart review analysed medication administrationdocumentation Ten patients from each of every nursing unitwere audited for 7 days

General conclusions MARSThere is limited evidence to suggest that introducing MARS

committee can significantly reduce the incidence of medicationadministration documentation errors

Control standard practice This involved a physician filling out apre-printed insulin order form A computerised MAR was gener-ated by the pharmacist each evening to be used to record thetimes of administration of insulin to each patient the following



Data were analysed to determine the number of occasionswhere insulin was administered within 60 min of blood glu-cose determination and the mean time between blood

day The dose of insulin to be delivered was determined accord-ing to a sliding scale based on a result from the patients bloodglucose test No single method of blood glucose determinationwas used by staff

Treatment involved three changes to standard practice1 A nursing education program discussing the prevention of

insulin administration errors and the importance of the timingbetween determination of a blood glucose and the subse-quent administration of insulin to a patient

2 Introduction of bedside blood glucose monitors to all units3 The computerised MAR was changed so that time and dose

of insulin were not recorded and therefore had to be recordedby the nurse at time of administrationAll MAR records from 1 month were examined for the month

before the change and at 6 months after the implementation ofthe quality improvement plan Insulin dose was compared withtime of blood glucose time entered

glucose determination and insulin delivery for four times(breakfast lunch dinner and bedtime) for each unit Theresults for each unit and pooled results are shown inTables 16 and 17

Overall the number of cases that received insulin within60 min of a blood glucose test improved significantly(Table 16) However individually this improvement was onlyseen on Units 1 and 2 Examination of time periods in whicha significant reduction in time interval between time ofblood glucose test and insulin administration was seen atbreakfast dinner and bedtime in Unit 1 but only at breakfastin Unit 2 and lunch in Unit 3 (Table 17)

General conclusions process change for insulin administrationThere is limited evidence to suggest that providing educa-

tion on diabetes management to nurses and the provision ofbedside blood glucose monitors can significantly reduce thetime between blood glucose measurement and insulinadministration

Table 16 Number of cases receiving insulin within 1 h of blood glucose testing

Study Level of evidence Quality Population Unit Insulin delivered le60 min () OR (95 CI)

Control Treatment

Heatlie200318

III-3 QS 611 Nurses on 3 units 1 86176 (489) 132185 (714) 26 (17 40)Before and afterstudy

Clinical importance 14

2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)

CI confidence interval OR odds ratio QS quality score R relevance Unit 1 cardiac progressive Unit 2 cardiac thoracic and neurosurgical Unit 3 orthopaedic

Table 17 Time interval between blood glucose determination and insulin administration (min)

Study Level of evidence Quality Population Unit Time from blood glucose test to insulin delivery (min)

P

Control Treatment

n Mean plusmn SD n Mean plusmn SD

Heatlie200318

III-2Control study


Nurses on3 units

1Breakfast 26 1255 plusmn 495 41 461 plusmn 230 000Lunch 50 534 plusmn 284 50 569 plusmn 340 058Dinner 50 700 plusmn 468 50 500 plusmn 319 001Bedtime 50 607 plusmn 416 44 381 plusmn 326 001



P probability (bold indicates significance) QS quality score R relevance SD standard deviation Unit 1 cardiac progressive Unit 2 cardiac thoracic and neurosurgical Unit 3 orthopaedic



Quality of medication instruction to patients in the community

During the finalisation of this review a single prospectivecohort study was identified concerning the quality ofinstructions given to older adults taking warfarin digoxinand phenytoin when filling a prescription in the commu-nity47 Patients receiving these drugs were selected becauseof the narrow therapeutic window of these medications andthe resulting higher risk of severe adverse events This reportdiscusses only the baseline survey data from telephone inter-views of over 4955 persons on the receipt of informationand quality of that information concerning their prescriptiondrugs at time of filling The survey results suggested thatalmost one-third of responders reported not receiving anyinstruction on the use of these medications

Discussion

The original goal of this systematic review was to evaluateinterventions to improve medication error incidence rates ingeriatric settings However it soon became apparent thatlittle research had been performed in strictly this environ-ment Persons aged 55 years and over account for a largeproportion of admitted patients and 496 of separations48

Therefore it was considered appropriate to include studiesfrom all clinical environments

Types and causes of medication errors

Studies examining the types and causes of medication errorsoccurring in older adults (ge65 years) are limited Howeverevidence is available on the general population and is takento be representative of those issues that would arise in thegeriatric setting

Medication errors in the hospital setting have been stud-ied extensively and the most common types of errors havebeen identified generally as prescriptionmedication order-ing errors dispensing errors errors in administration ofmedicines and errors in the medication record Specificallythese errors can most often be categorised as omissions(gt25) overdoses (20) wrong medicines (10) drug ofaddiction discrepancy (lt5) incorrect labelling (lt5) oran adverse drug reaction (lt5) However little is known asto why medication errors occur in Australian hospitals Fail-ure to read or misreading the chart and a lack of robustsystems for prescribing and ordering were suggested as thereasons for most of these errors4

Based on limited Australian data on prescription errorsapproximately 2 of all prescriptions have the potential tocause an adverse event with the most common causes beingthe wrong or ambiguous dose missing dose or the direc-

tions for use were unclear or absent This can be comparedwith other countries in which the medication error rateshave been reported to be between 2 and 76

Among the most common errors and their causes relatedto medication that are encountered in community practice(ie community pharmacies and general practices) are inap-propriate drugs prescribing errors administration errorsand inappropriate dose errors4 The factors contributing tothese errors were forwarded by the doctors surveyed andnot from empirical evidence Most commonly cited reasonsfor medication errors in a community setting are poor com-munication between patient and health professionals actionof others (not GP or patient) error of judgement poorcommunication between health professionals patient con-sulted another medical officer and failure to recognise signsand symptoms

The most common types of dispensing errors reported bypharmacists are the selection of the incorrect strengthincorrect product or misinterpretation of a prescription Themajor reason for selecting the incorrect strength or producthas been described as the result of lsquolook alikersquo or lsquosoundalikersquo error

In an Australian survey of 209 community pharmaciststhe major factors cited for contributing to dispensing errorswere high prescription volume overwork fatigue interrup-tions to dispensing lsquolook alike sound alikersquo drug names

Other factors that have been suggested as contributingto medication errors are inadequate continuity of carebetween the hospital and the community after discharge ofa patient multiple healthcare providers where medicinescan be prescribed by more than one doctor keeping unnec-essary medications generic namestrade names and misun-derstanding the label instructions However the effect ofthese factors on medication error and adverse drug eventshas not been studied

Effectiveness

Numerous interventions to reduce the incidence of medica-tion errors were identified that evaluated all steps in thepathway of delivery of medication to the patient Includedin this review are evaluations of computerised ordering byphysicians drug order checking by pharmacists supply anddelivery of drugs to the respective medical units and admin-istration of drugs to the patients by nursing staff Withineach step of the process different types of interventionswere evaluated such as the use of single versus doublechecking by nurses before administration of a drug or theuse of a dedicated nurse with a distinctive lsquojacketrsquo to identifythem as performing drug administration and not to be



disturbed Overall however for a number of the interven-tions discussed in this review the level of evidence was low(small sample sizes before and after studies) or the resultswere poorly reported or inconclusive

It was stressed in many of the researches reviewed herethat medication errors do not necessarily translate intoadverse drug events that could result in harm to patients Itwas apparent from this literature that once a definition of amedication error was created the ease of determination ofan error was dependent primarily on the level of reporting(ie the ease and willingness of clinicians to report an error)However the resulting effect of a medication error if anyon the patient was much harder to establish and thereforemany studies did not extend their outcomes to include thiseventuality

In a number of studies the number of reported medica-tion errors was actually seen to increase after implementa-tion of an intervention This may have been the result ofincreased vigilance and improved reporting systems ratherthan an increase in the incidence of errors Therefore insome studies it was impossible to accurately determine theeffectiveness of the specified intervention


Computerised systems consisted of a variety of interventionsincluding CPOE automated dispensing bedside terminalscomputer-generated MAR alert systems and bar coding

In summary there was good evidence that CPOE systemcombined with CDSS is effective in reducing medicationerrors in a general hospital population6 However therewas lower-level evidence for the effectiveness of computer-generated MAR computer adverse drug event detectionand alerts Finally there was no evidence to suggest theuse of bedside terminal systems or bar coding patientsor medications reduces medication error incidence orthat automated dosing systems reduce medication errorincidence but only reduce errors in filling of drawers bytechnicians

The majority of the research was in the use of CPOE toreduce medication errors and ultimately adverse drugevents Although CPOE was shown to significantly decreasethe incidence of medication errors it was noted that therewas little evidence for CPOE andor CDSS reducing adversedrug events and actual patient harm6

A single report on the introduction of a computerisedMAR reported only that medication errors deceased fromone year to the next by 1811 It was assumed from thereport that medication errors were defined as a discrepancybetween the MAR and the pharmacy order but this was not

implicitly stated A positive of the new MAR was its readabil-ity over handwritten documents

The use of a computer alert system in one study showedthat in 44 of cases where the system alerted the physicianto a potential risk of an adverse drug event-related injurythe physician was unaware of the risk27 This suggests thatthe system may be able to prevent a significant number ofpotentially harmful medical errors However the systemconsisted of only 37 drug-specific adverse drug events andtherefore would need to be expanded and updated toencompass a greater variety of risk

Providing bedside terminal systems in one communityhospital was evaluated for its effect on registered nurse timespent in direct care activities overtime attitudes towardsthe technology and unit medication error rate14 No differ-ence in unit error rates was noted However the studyduration for pre- and post-intervention observation wasshort at 40 h each and the errors were counted from reportson incident forms

Identification of a single study in one systematic review6

found that nurse use of bar codes in a point of care infor-mation system decreased the medication error rate in thehospital from 017 before the system was instituted to005 after (P value not reported) Although this result wasencouraging the use of the bar coding device was lsquoeasilyand frequently circumventedrsquo bringing into question thereal contribution of the device to the overall error ratedecrease The reasons for this were not described

However a recent ethnographic study of nurse physicianand pharmacist interaction with a newly instituted comput-erised system of BCMA identified five negative themes (side-effects) that may elucidate the reason for the under-use ofthe bar coding system reported in the review26

1 nurse confusion over automated removal of medicationsby the BCMA

2 degraded coordination between the nursing staff and thephysicians

3 nurses dropped activities to reduce workload during busyperiods

4 increased prioritisation of monitored activities duringbusy periods and

5 decreased ability to deviate from routine sequencesThe available evidence from a systematic review for the

use of automated dispensing was found to be generally poorand did not support the suggestion that automated dispens-ing systems improved outcomes6 In a single study the useof an automated point-of-use dose system significantlyreduced the rate of error in filling of dosage carts by tech-nicians only28




Individual medication supply systems have been shown toreduce medication error rates compared with other dispens-ing systems such as ward stock approaches However onesystematic review suggested that the use of these systemsshifts the chances for error from the nursing ward into thepharmacy where distractions are also common and errorswill occur6


Few studies were identified that examined the effectivenessof nursing education or training programs on the preventionof adverse drug events From the two studies that wereincluded there is no evidence to suggest that educationaddressing medication calculation or a yearly medicationexamination is effective in reducing medication errors1224

Looked at another way neither written medication exami-nations nor education on medication calculation couldimprove nurse competence to prevent errors beyond theskills they had already accrued

Pharmacists

There is good evidence to suggest a role for clinical phar-macists in preventing adverse drug events in the inpatientsetting From a systematic review pharmacist interventionin one study resulted in a 66 decrease in preventableadverse drug events because of medical ordering and astudy of geriatric patients at the time of discharge foundstatistically significant decreases in medication errors6 Thevalue of the presence of a pharmacist during medicationrounds was also determined in two other studies2246 Bothstudies displayed a decrease in the number of medicationerrors per 1000 patient days with the improved availabilityof a pharmacist for consultation

Evidence for the effectiveness of pharmacists in reducingadverse drug events in the outpatient setting is lesscompelling

Nursing care models

The strongest evidence suggests that having two nursescheck medication orders before dispensing medication sig-nificantly reduces the incidence of medication errors21 How-ever the authors question the clinical advantage of thispolicy and do not recommend it Weaker evidence sug-gested that single checking could be as safe as doublechecking but was reliant on the number of medicationerrors reported in the medication incident records and mightbe a conservative estimate of the actual number of medica-tion errors that actually occurred20 It has been demon-

strated that actual error rate could be 33 higher thanreported rates49

There is no evidence to suggest that providing designatednurses to dispense medication significantly reduces the inci-dence of medication errors141625 However the use of thefocused or Medsafe protocols in which nurses are identifiedas lsquonot to be disturbedrsquo can reduce distractions to nursesduring medication administration25 Distractions were usedas a surrogate measure of the potential for a medicationerror Although these strategies did not eliminate distrac-tions during the medication lsquocyclersquo these interventions wereshown to reduce them by as much as 87 compared withcustomary medication rounds The weakness of this studymay lie in the method of collection of distractions using apreviously unvalidated collection tool and the unavoidableuse of an unblinded observer

Employment of a MARS committee was shown to havea positive effect on reducing the number of medicationadministration documentation errors over a period of1 year29 This is likely due to the heightened awareness ofmedication error prevention and reporting

There is limited evidence from one study to suggest thatintroducing the PIPC model significantly reduces the inci-dence of medication errors23 This model was instituted inan attempt to reduce the workload on registered nurses bydelegating less clinical tasks to a multiskilled technicianDespite the claim that the PIPC model was effective atsignificantly reducing the medication error ratio (errorspatient day P = 0008) the data for before the institutionof the PIPC model and after were not presented and there-fore could not be verified

As an example of the implementation of process changeto improve the delivery of a specific drug and reduce thelikelihood of an adverse event diabetes education to nursesand the installation of blood glucose testing units in allwards were assessed18 Overall the number of cases thatreceived insulin within 60 min of a blood glucose testimproved significantly However when individual units wereevaluated this improvement was not universal Examinationof time periods in which a significant reduction in timeinterval between time of blood glucose test and insulinadministration was seen at three time periods (breakfastdinner and bedtime) for one unit but at only one timeperiod (breakfast or lunch) in the other two units The unitshowing greatest improvement showed consistently highermean time intervals between blood glucose testing andinsulin delivery during the control phase of the study at allmeasurement periods (means of 53ndash125 min) whereas themean times of the other units were all below 60 min



Recommendations

Implications for practice


bull CPOE should be considered as this strategy may reducethe risk of misreading medication orders


bull Individual patient medical supply should be consideredfor use wherever possible

Pharmacists

bull Where possible pharmacists should be made available fordouble checking medication orders and for consultation

Nursing care models

bull Double checking of medication orders by nurses beforeadministration of medicines can reduce the number ofmedication errors

bull Identifying a dedicated nurse for medication administra-tion may reduce the number of medication errorsthrough the reduction of distractions

bull The use of a MARS committee may have a positive effecton reducing medication errors likely because of theheightened awareness of medication error preventionand reporting

Implications for research

More research is needed to determinebull the effectiveness of MAR bedside terminals computer

alert systems and bar codes to reduce medication errorsbull the effectiveness of educational interventions to reduce

medication errorsbull whether the use of multiskilled technicians partnering

with nurses to reduce their workload (PIPC model) canreduce the incidence of medication errors and

bull whether the use of dedicated nurses or double checkingcan reduce the incidence of medication errors

References

1 Australian Institute of Health and Welfare Older Australia at aGlance 3rd edn Canberra AIHW amp DOHA 2002 Report NoAIHW Cat No AGE 25

2 Roughead EE Gilbert AL Primrose JG Sansom LN Drug-related hospital admissions a review of Australian studies pub-lished 1988ndash1996 Med J Aust 1998 168 405ndash8

3 Leape LL Brennan TA Laird N et al The nature of adverseevents in hospitalized patients Results of the Harvard MedicalPractice Study II N Engl J Med 1991 324 377ndash84

4 Australian Council for Safety and Quality in Health Care SecondNational Report on Patient Safety Improving Medication SafetyCanberra Australian Council for Safety and Quality in HealthCare 2002

5 Strohecker S Medication management Polished automationtools allow patient safety to shine Nurs Manage 2003 34 3436 38 passim

6 Shojania KG Duncan BW MacDonald KM Watchter RM ACritical Analysis of Patient Safety Practices Rockville Agency forHealthcare Research and Quality 2001 Report No 43

7 NHMRC How to Review the Evidence Systematic Identificationand Review of the Scientific Literature Handbook Series on Pre-paring Clinical Practice Guidelines Canberra National Healthand Medical Research Council 2000 Endorsed November1999 Report No ISBN 1864960329

8 Khan KS Ter Riet G Glanville JM Sowden AJ Kleijnen J Under-taking Systematic Reviews of Research on Effectiveness CRDrsquosGuidance for Those Carrying Out or Commissioning Reviews CRDReport 2nd edn York NHS Centre for Reviews and Dissemi-nation University of York 2001 CRD Report No 4

9 Kaushal R Shojania KG Bates DW Effects of computerizedphysician order entry and clinical decision support systems onmedication safety a systematic review Arch Intern Med 2003163 1409ndash16

10 Westwood M Rodgers M Sowden A Patient Safety A Mappingof the Research Literature Birmingham University of Birming-ham NHS Centre for Reviews and Dissemination 0000 PatientSafety Research Programme Report No PS001 httppcpohbhamacukpublichealthpsrppublicationshtm

11 Adams C Computer-generated medication administrationrecords Nurs Manage 1989 20 22ndash3

12 Bayne T Bindler R Effectiveness of medication calculationenhancement methods with nurses J Nurs Staff Dev 1997 13293ndash301

13 Brown HN Brooks L Liner ST LPNs as medication nurses NursManage 1993 24 83ndash4

14 Brown SJ Cioffi MA Schinella P Shaw A Evaluation of theimpact of a bedside terminal system in a rapidly changingcommunity hospital Comput Nurs 1995 13 280ndash4

15 Cerne F Study finds bedside terminals prove their worth Hos-pitals 1989 63 72

16 Greengold NL Shane R Schneider P et al The impact ofdedicated medication nurses on the medication administrationerror rate a randomized controlled trial Arch Intern Med 2003163 2359ndash67

17 Hawkey CJ Hodgson S Norman A Daneshmend TK GarnerST Effect of reactive pharmacy intervention on quality of hos-pital prescribing BMJ 1990 300 986ndash90

18 Heatlie JM Reducing insulin medication errors evaluation of aquality improvement initiative J Nurs Staff Dev 2003 19 92ndash8

19 Heinemann D Lengacher CA VanCott ML Mabe P SwymerS Partners in patient care measuring the effects on patientsatisfaction and other quality indicators Nurs Econ 1996 14276ndash85

20 Jarman H Jacobs E Zielinski V Medication study supportsregistered nursesrsquo competence for single checking Int J NursPract 2002 8 330ndash5

21 Kruse H Johnson A OrsquoConnell D Clarke T Administering non-restricted medications in hospital the implications and cost ofusing two nurses Aust Clin Rev 1992 12 77ndash83

22 Kucukarslan SN Peters M Mlynarek M Nafziger DA Pharma-cists on rounding teams reduce preventable adverse drugevents in hospital general medicine units Arch Intern Med2003 163 2014ndash18

23 Lengacher CA Mabe PR Bowling CD Heinemann D Kent KVan Cott ML Redesigning nursing practice The partners inpatient care model J Nurs Admin 1993 23 31ndash7



24 Ludwig Beymer P Czurylo KT Gattuso MC Hennessy KA RyanCJ The effect of testing on the reported incidence of medica-tion errors in a medical center J Contin Educ Nurs 1990 2111ndash17

25 Pape TM Applying airline safety practices to medicationadministration MedSurg Nurs 2003 12 77ndash93quiz 94

26 Patterson ES Cook RI Render ML Improving patient safetyby identifying side effects from introducing bar coding inmedication administration J Am Med Inform Assoc 2002 9540ndash53

27 Raschke RA Gollihare B Wunderlich TA et al A computer alertsystem to prevent injury from adverse drug events develop-ment and evaluation in a community teaching hospital JAMA1998 280 1317ndash20

28 Ray MD Aldrich LT Lew PJ Experience with an automatedpoint-of-use unit-dose drug distribution system Hosp Pharm1995 30 18 20ndash3 27ndash30

29 Schaubhut RM Jones C A systems approach to medicationerror reduction J Nurs Care Qual 2000 14 13ndash27

30 Spencer DC Leininger A Daniels R Granko RP Coeytaux RREffect of a computerized prescriber-order-entry system onreported medication errors Am J Health Syst Pharm 2005 62416ndash19

31 Bates DW Leape LL Cullen DJ et al Effect of computerizedphysician order entry and a team intervention on preventionof serious medication errors JAMA 1998 280 1311ndash16

32 Bates DW Teich JM Lee J et al The impact of computerizedphysician order entry on medication error prevention J Am MedInform Assoc 1999 6 313ndash21

33 Overhage JM Tierney WM Zhou XH McDonald CJ A random-ized trial of lsquocorollary ordersrsquo to prevent errors of omissionJ Am Med Inform Assoc 1997 4 364ndash75

34 Teich JM Merchia PR Schmiz JL Kuperman GJ Spurr CD BatesDW Effects of computerized physician order entry on prescrib-ing practices Arch Intern Med 2000 160 2741ndash7

35 Chertow GM Lee J Kuperman GJ et al Guided medicationdosing for inpatients with renal insufficiency JAMA 2001 2862839ndash44

36 Evans RS Pestotnik SL Classen DC et al A computer-assistedmanagement program for antibiotics and other antiinfectiveagents N Engl J Med 1998 338 232ndash8

37 Burton ME Ash CL Hill DP Jr Handy T Shepherd MD VaskoMR A controlled trial of the cost benefit of computerizedbayesian aminoglycoside administration Clin Pharmacol Ther1991 49 685ndash94

38 Evans RS Classen DC Pestotnik SL Lundsgaarde HP Burke JPImproving empiric antibiotic selection using computer decisionsupport Arch Intern Med 1994 154 878ndash84

39 Hurley SF Dziukas LJ McNeil JJ Brignell MJ A randomizedcontrolled clinical trial of pharmacokinetic theophylline dosingAm Rev Respir Dis 1986 134 1219ndash24

40 Casner PR Reilly R Ho H A randomized controlled trial ofcomputerized pharmacokinetic theophylline dosing versusempiric physician dosing Clin Pharmacol Ther 1993 53 684ndash90

41 White RH Hong R Venook AP et al Initiation of warfarintherapy comparison of physician dosing with computer-assisted dosing J Gen Intern Med 1987 2 141ndash8

42 Mungall DR Anbe D Forrester PL et al A prospective random-ized comparison of the accuracy of computer-assisted versusGUSTO nomogram-directed heparin therapy Clin PharmacolTher 1994 55 591ndash6

43 Briggs B Medication error reduction hopes pinned on CPOEHealth Data Manag 2002 10 42ndash6

44 Boyle CM Maxwell DJ Meguid SE Ouaida D Krass I Misseddoses an evaluation in two drug distribution systems Aust JHosp Pharm 1998 28 413ndash16

45 McNally KM Page MA Sunderland VB Failure-mode andeffects analysis in improving a drug distribution system Am JHealth Syst Pharm 1997 54 171ndash7

46 Shah NR Emont AJ Johnson VP Total quality management inaction pharmacy system changes to decrease medication inci-dents and increase clinical services Hosp Pharm 1994 29 679ndash80

47 Metlay JP Cohen A Polsky D Kimmel SE Koppel R HennessyS Medication safety in older adults home-based practice pat-terns J Am Geriatr Soc 2005 53 976ndash82

48 Australian Institute of Health and Welfare (AIHW) AustralianHospital Statistics 2003ndash04 Health Services Series No 23Canberra AIHW 2005

49 Larrabee JH Ruckstuhl M Salmons J Smith L Interdisciplinarymonitoring of medication errors in a nursing quality assuranceprogram J Nurs Qual Assur 1991 5 69ndash78

50 Alemagno SA Niles SA Treiber EA Using computers toreduce medication misuse of community-based seniorsresults of a pilot intervention program Geriatr Nurs 2004 25281ndash5

51 Aufseeser Weiss MR Ondeck DA Medication use risk manage-ment hospital meets home care Home Health Care Manage-ment and Practice J Nurs Care Qual 2001 15 50ndash7

52 Ayuthya SK Malathum K Matangkasombut O Restriction ofvancomycin use at a university hospital in Thailand Am J HealthSyst Pharm 2003 60 1053ndash4

53 Bolton P Tipper S Tasker JL Medication review by GPs reducespolypharmacy in the elderly a quality use of medicines pro-gram Aust J Prim Health 2004 10 78ndash82

54 Dhalla IA Anderson GM Mamdani MM Bronskill SE Sykora KRochon PA Inappropriate prescribing before and after nursinghome admission J Am Geriatr Soc 2002 50 995ndash1000

55 Dimant J Medication errors and adverse drug events in nursinghomes problems causes regulations and proposed solutionsJ Am Med Dir Assoc 2001 2 81ndash93

56 Meredith S Feldman PH Frey D et al Possible medicationerrors in home healthcare patients J Am Geriatr Soc 2001 49719ndash24

57 Mutter M One hospitalrsquos journey toward reducing medicationerrors Jt Comm J Qual Saf 2003 29 279ndash88

58 Nelson R The experience at Veteransrsquo Hospitals though notperfect nurses say a bar-coding system means patients aresafer Am J Nurs 2004 104 65

59 Papastrat K Wallace S Educational innovations Teaching bac-calaureate nursing students to prevent medication errors usinga problem-based learning approach J Nurs Educ 2003 42459ndash64

60 Roark DC Bar codes amp drug administration can new technol-ogy reduce the number of medication errors Am J Nurs 2004104 63ndash6

61 Van den Bemt PMLA Postma MJ Van Roon EN Chow MCCFijn R Brouwers JRBJ Costndashbenefit analysis of the detection ofprescribing errors by hospital pharmacy staff Drug Saf 200225 135ndash43

62 Whitman GR Kim Y Davidson LJ Wolf GA Wang S The impactof staffing on patient outcomes across specialty units J NursAdmin 2002 32 633ndash9



Appendix I

Supporting committee for medication management

Associate Professor Susan Koch (Chair) ACEBAC Director CollaborationProfessor Helen Baker (Professor of Nursing) Victoria UniversityMr David Cooper Aged Care Standards amp Accreditation AgencyMrs Lisa Derndorfer (ACEBAC administrator)Ms Cathie Edgar (Nurse Educator) Bundoora Extended Care Centre (BECC)Mrs Mandy Heather (Director of Nursing) Bundoora Extended Care Centre (BECC)Ms Susan Hunt Nurse Consultant and EducatorDr Kwang Lim (Geriatrician) Broadmeadows Health ServiceDr Michael Murray (Geriatrician) St Georgersquos Health ServiceMs Karen OrsquoKeefe (Director of Nursing) Caulfield General Medical CentreProfessor Kenn Raymond (Professor of Pharmacology) La Trobe University BendigoMr Dipak Sanghvi (Pharmacist) The Pharmacy Guild of AustraliaDr Michael Whishaw (Geriatrician) Melbourne Extended Care and Rehabilitation Service

ACEBAC Australian Centre for Evidence Based Aged Care



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Out

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s tim

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dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

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imp

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able

R no

t es

timab

le

Com

mun

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29

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) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III

Studies excluded from the review

Appendix IV

Example search strategies

Search strategy for PubMed (contains MEDLINE andpre-MEDLINE)

Study Reason for exclusion

Alemagno et al 200450 Wrong outcomeAufseeser Weiss and Ondeck

200151Discussion paper

Ayuthya et al 200352 Wrong outcomeBates et al 199831 Described in systematic review9

Bates et al 199932 Described in systematic review9

Bolton et al 200453 Wrong outcomeBoyle et al 199844 Described in review4

Briggs 200243 Discussion paperBurton et al 199137 Described in systematic review9

Casner et al 199340 Described in systematic review9

Chertow et al 200135 Described in systematic review9

Dhalla et al 200254 No interventionDimant 200155 No interventionEvans et al 199438 Described in systematic review9

Evans et al 199836 Described in systematic review9

Hurley et al 198639 Described in systematic review9

Larrabee et al 199149 No interventionMcNally et al 199745 Wrong outcomeMeredith et al 200156 Wrong outcomeMungall et al 199442 Described in systematic review9

Mutter 200357 Wrong outcomeNelson 200458 Descriptive no interventionOverhage et al 199733 Described in systematic review9

Papastrat and Wallace 200359 Wrong outcomeRoark 200460 Discussion paperStrohecker 20035 Discussion paperTeich et al 200034 Described in systematic review9

Van den Bemt et al 200261 Wrong outcomeWestwood et al10 References assessed separatelyWhite et al 198741 Described in systematic review9

Whitman et al 200262 Wrong outcome

Searchnumber

Search Number ofcitations

1 Search lsquomedication errorsrsquo[MeSH Terms] 5 2072 Search lsquoagedrsquo[MeSH Terms] 1 431 5693 Search lsquoprescriptions drugrsquo[MeSH Terms] 13 4854 Search lsquomedication errorsrsquo[TitleAbstract] 1 0505 Search lsquoagedrsquo[TitleAbstract] 182 8616 Search lsquoelderlyrsquo[TitleAbstract] 99 1917 Search lsquoadultsrsquo[TitleAbstract] 154 9488 Search lsquodrugrsquo[TitleAbstract] 429 3709 Search lsquoadverse eventrsquo[TitleAbstract] 3 89110 Search lsquomedicationrsquo[TitleAbstract] 61 16411 Search (((1)) OR (4)) OR (9) 9 30612 Search ((((2)) OR (5)) OR (6)) OR (7) 1 673 45913 Search (((3)) OR (8)) OR (10) 486 51014 Search (((11)) AND (12)) AND (13) 960

Appendix V

Health Technology Assessment (HTA) websites

Australia

bull Australian Safety and Efficacy Register of New Interven-tional Procedures ndash Surgical (ASERNIP-S) httpwwwsurgeonsorgopenasernip-shtm

bull Centre for Clinical Effectiveness (Monash University Aus-tralia) httpwwwmedmonasheduauhealthservicescceevidence

bull Health Economics Unit Monash University httpchpebusecomonasheduau

Austria

bull Institute of Technology AssessmentHTA unit httpwwwoeawacatitae1-3htm

Canada

bull Agence drsquoEvaluation des Technologies et des ModesdrsquoIntervention en Santeacute (AETMIS) httpwwwaetmisgouvqccaenindexhtm

bull Alberta Heritage Foundation for Medical Research(AHFMR) httpwwwahfmrabcapublicationshtml

bull Canadian Coordinating Office for Health TechnologyAssessment (CCHOTA) httpwwwccohtacanewwebpubapppubsasp

bull Canadian Health Economics Research Association(CHERAACRES) ndash Cabot database httpwwwmycabotca

bull Centre for Health Economics and Policy Analysis (CHEPA)McMaster University httpwwwchepaorg

bull Centre for Health Services and Policy Research (CHSPR)University of British Columbia httpwwwchsprubcca

bull Health Utilities Index (HUI) httpwwwfhsmcmastercahugindexhtm

bull Institute for Clinical and Evaluative Studies (ICES) httpwwwicesonca

Denmark

bull Danish Institute for Health Technology Assessment(DIHTA) httpwwwdihtadkpublikationerindex_ukasp

Finland

bull Finnish Office for Health Technology Assessment(FINOHTA) httpwwwstakesfifinohtae

France

bull LrsquoAgence Nationale drsquoAccreacuteditation et drsquoEvaluation enSanteacute (ANAES) httpwwwanaesfr



Germany

bull German Institute for Medical Documentation and Infor-mation (DIMDI)HTA httpwwwdahtadimdide

bull German Scientific Working Group of Technology Assess-ment httpwwwepimh-hannoverde(eng)htahtml

The Netherlands

bull Health Council of the Netherlands Gezondheidsraadhttpwwwgrnlengelswelcomeframesethtm

New Zealand

bull New Zealand Health Technology Assessment (NZHTA)httpnzhtachmedsacnz

Norway

bull Norwegian Centre for Health Technology Assessment(SMM) httpwwwoslosintefnosmmPublicationsEngsmdragFramesetPublicationshtm

Spain

bull Agencia de Evaluacioacuten de Tecnologias Sanitarias Institutode Salud lsquoCarlos IIIrsquoIHealth Technology AssessmentAgency (AETS) httpwwwisciiiesaetscdochtm

bull Catalan Agency for Health Technology Assessment(CAHTA) httpwwwaatmescgi-binframeplangpuhtml

Sweden

bull Swedish Council on Technology Assessment in HealthCare (SBU) httpwwwsbuseadminindexasp

Switzerland

bull Swiss Network on Health Technology Assessment(SNHTA) httpwwwsnhtach

United Kingdom

bull Health Technology Board for Scotland httpwwwhtbsorguk

bull National Health Service Health Technology Assessment(UK)National Coordinating Centre for Health Technol-ogy Assessment (NCCHTA) httpwwwhtanhswebnhsuk

bull University of York NHS Centre for Reviews and Dissemina-tion (NHS CRD) httpwwwyorkacukInstitutecrd

bull National Institute for Clinical Excellence (NICE) httpwwwniceorgukindexhtm

United States

bull Agency for Healthcare Research and Quality (AHRQ) httpwwwahrqgovclinictechixhtm

bull Harvard Center for Risk Analysis ndash Cost-Utility AnalysisDatabase Project (comprehensive league table) httpwwwhcraharvardedutablesdatahtml

bull US Department of Veterans Affairs Technology AssessmentProgram (VATAP) httpwwwvagovresdevprtpubs_individualcfmwebpage=pubs_ta_reportshtm

Appendix VI

Critical appraisal checklists

Systematic review critical appraisal checklist

Source Khan et al 20018

Title of assessmentTitle of systematic reviewAuthor(s)YearComparatorsScore 61 What is the reviewrsquos objective

What were the populationparticipants interventionsoutcomes and study designs

2 What sources were searched to identify primary studiesWhat sources (eg databases) were searched and wereany restrictions by date language and type of publicationused Were other strategies used to identify research

3 What were the inclusion criteria and how were theyapplied

4 What criteria were used to assess the quality of primarystudies and how were they applied

5 How were the data extracted from the primary studies6 How were the data synthesised

How were differences between studies investigatedHow were the data combined Was it reasonable to com-bine the studiesWhat were the summary results of the reviewDo the conclusions flow from the evidence reviewed

Rank scoring for appraising the clinical importance of benefitharm

Source NHMRC 20007

Title of reviewTitle of studyAuthor(s)YearComparatorsClinically important effect



Rank Score 4

Rank scoring for classifying the relevance of evidence

Source NHMRC 20007

Title of reviewTitle of study

Ranking Clinical importance of benefitharm

1 A clinically important benefit for the full range of plausible estimatesThe confidence limit closest to the measure of no effect (the lsquonullrsquo) rules out a clinically unimportant effect of the intervention

2 The point estimate of effect is clinically important BUT the confidence interval includes clinically unimportant effects

3 The confidence interval does not include any clinically important effects

4 The range of estimates defined by the confidence interval includes clinically important effects BUT the range of estimates defined by the confidence interval is also compatible with no effect or a harmful effect

Author(s)YearComparatorsRank Score 5

Checklist for appraising the quality of intervention studies

Ranking Relevance of the evidence

1 Evidence of an effect on patient-relevant clinical outcomes including benefits and harms and quality of life and survival

2 Evidence of an effect on a surrogate outcome that has been shown to be predictive of patient-relevant outcomes for the same intervention

3 Evidence of an effect on proven surrogate outcomes but for a different intervention

4 Evidence of an effect on proven surrogate outcomes but for a different intervention and population

5 Evidence confined to unproven surrogate outcomes









lated from individual comparative studies containing count data where possible Allother data were presented in a narrative summary

Results Strategies that have some evidence for reducing medication incidents arebull computerised physician ordering entry systems combined with clinical decision

support systemsbull individual medication supply systems when compared with other dispensing

systems such as ward stock approachesbull use of clinical pharmacists in the inpatient settingbull checking of medication orders by two nurses before dispensing medicationbull a Medication Administration Review and Safety committee andbull providing bedside glucose monitors and educating nurses on importance of

timely insulin administrationIn general the evidence for the effectiveness of intervention strategies to reduce

the incidence of medication errors is weak and high-quality controlled trials areneeded in all areas of medication prescription and delivery

Key words intervention studies medication errors nursing prevention

Introduction

Background

In Australia around 59 of the general population usesprescription medication with this number increasing toabout 86 in those aged 65 and over and with 83 of thepopulation over 85 using two or more medicationssimultaneously1

A recent report suggests that between 2 and 3 of allhospital admissions in Australia may be medication related2

The Harvard Medical Practice study in the USA found thatin hospital patients disabled by some form of medicaltreatment 19 of recorded adverse events were related tomedications3

Older Australians have higher rates of medication incidentsbecause of higher levels of medicine intake and increasedlikelihood of being admitted to hospital (hospital statisticsbeing the main source of medication incident reporting)4

In the community setting it has been estimated that upto 400 000 adverse drug events may be managed in generalpractices each year in Australia4

The financial burden is staggering with one estimate put-ting the cost of preventable medication errors in the USAalone between $17 and $29 billion per year5 In Australiathe cost has been estimated at over $350 million annually2

What are the types and causes of medication errors

Studies examining the types and causes of medication errorsoccurring in older adults (ge65 years) are limited Howeverevidence is available on the general population and is taken

to be representative of those issues that would arise in thegeriatric setting Where specific reference to older adults isfound it is highlighted in this report

In a recent review by the Australian Council for Safety andQuality in Health Care the types of medication errors mostfrequently encountered in an Australian healthcare settingand their likely causes were presented4 The results of thisreport present the best data with a particular focus on Aus-tralia that is presently available and are summarised asfollows

Errors in hospital The most common errors related tomedication that are encountered in hospitals in Australia arebull prescriptionmedication ordering errorsbull dispensing errorsbull errors in administration of medicines andbull errors in the medication record

Table 1 Types of medication errors in general medical practice

Type of incident Rate per 100 incidents

Inappropriate drug 30Prescribing error 22Administration error 18Inappropriate dose 15Side-effect 13Allergic reaction 11Dispensing error 10Overdose 8System inadequacies 7Drug omitted or withheld 6

Source Australian Council for Safety and Quality in Health Care (2002 p 33)4





















23


23


treatment10
















Objectives



Review method



Types of studies




nurses)







Types of outcomes



Search strategy





















Search phases







Level of evidence


Quality of evidence











measures used






Results
























































Before After P

Spenceret al200530









Ray et al199528










Brownet al199514
















































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

2 nu

rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

eeks

1 n

urse

ad

min

iste

ring

med

icat

ions

Con

trol

for

seco

nd 2

3 w

eeks

2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

edic

atio

nM

edic

atio

n ch

art

not

sign

ed

23 w

eeks

fo

r ea

ch

segm

ent

46 w

eeks

in t

otal

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Con

trol

led

tria

ls

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Kucu

kars

lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

al p

harm

acis

ts a

ndin

pat

ient

s ad

mitt

ed t

o 1

of2

inte

rnal

med

icin

e un

its

Con

trol

gro

up

n =

79M

ean

age

56

5 plusmn

196

yea

rs36

mal

e 4

3 fe

mal

eSt

udy

grou

pn

= 86

Mea

n ag

e 5

39

plusmn 19

8 y

ears

36 m

ale

50

fem

ale

Con

trol

p

atie

nts

in t

his

grou

p r

ecei

ved

stan

dard

ca

re f

rom

pha

rmac

ists

with

a

ratio

of

1 p

harm

acis

t fo

r ev

ery

30 p

atie

nts

Prev

enta

ble

drug

eve

nts

Even

ts1

000

pat

ient

day

sEv

ents

tot

al p

atie

nts

87 d

ays

fro

m5

Sep

tem

ber

to30

Nov

embe

r

Stud

y 2

clin

ical

pha

rmac

ists

as

sign

ed t

o p

atie

nt c

are

at

beds

ide

incl

udin

g ro

unds

do

cum

enta

tion

of

pha

rmac

othe

rap

y hi

stor

y an

d p

rovi

ding

dis

char

ge

coun

selli

ng

Pap

e

2003

25III

-2Q

S 7

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Med

ical

su

rgic

al u

nit

of a

cute

car

eho

spita

l TX

U

SA

Con

trol

led

tria

lC

onve

nien

ce s

amp

le o

f re

gist

ered

nur

ses

on a

m

edic

al s

urgi

cal u

nit

of 3

0 p

atie

nts

Con

trol

to

tal o

f 8

cycl

es

Nur

ses

used

cus

tom

ary

med

icat

ion

adm

inis

trat

ion

pro

cedu

res

Focu

sed

prot

ocol

to

tal o

f 8

cycl

es

A lsquo

spec

ial n

urse

rsquo de

sign

ated

and

sta

ff as

ked

to n

ot in

terr

upt

or d

istr

act

the

spec

ial n

urse

unl

ess

rela

ted

to m

edic

atio

ns

bein

g ad

min

iste

red

Med

safe

pro

toco

l to

tal o

f 8

cycl

es

Nur

se a

dmin

iste

ring

med

icat

ions

ask

ed to

wea

r a

spec

ial v

est

that

iden

tified

th

em a

s in

the

pro

cess

of

adm

inis

terin

g m

edic

atio

ns

Vest

labe

lled

with

a

lsquoMed

safe

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ple

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in

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qua

lity

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re

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Oth

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Stud

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Inte

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Out

com

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ngth

of

follo

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1989

15III

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t es

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por

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not

estim

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Nur

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sta

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Pre

sta

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be

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e co

mp

uter

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rmin

als

pro

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fu

ll cl

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al in

form

atio

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p

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nit

Med

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erro

rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

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ll RN

s in

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m

edic

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ente

rPr

e a

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s re

qui

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to p

ass

a ye

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inat

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N

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r of

med

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erro

rs

rep

orte

d on

inci

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for

ms

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for

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8-m

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rors

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in

cide

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orm

s re

cord

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or a

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the

fo

llow

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year

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men

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Clin

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Gen

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ases

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scrip

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ber

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ases

whe

re

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reci

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cha

nges

wer

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ade

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BCM

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inis

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rele

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N

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tan

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2000

29

III-3

QS

611

Clin

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imp

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R no

t es

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Gen

eral

ho

spita

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SA

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view

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nsec

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men

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of

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rors

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pat

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per

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por

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25

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data

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llect

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follo

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mon

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w-u

p

BCM

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bar

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inis

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et a

l

1995

28

III-3

QS

711

Clin

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im

por

tanc

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4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

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ant

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fol

low

ing

day

med

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adm

inis

trat

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for

each

pat

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nit

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e p

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in t

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to

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unit

ever

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h

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stat

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esta

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each

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ased

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s of

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uni

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he

med

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file

for

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p

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est

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d do

wnl

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th

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ntra

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min

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in r

eal

time

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it h

app

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Four

uni

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C

USA

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cens

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sPr

e n

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an

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l

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20

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Clin

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imp

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t es

timab

le

Adu

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pat

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units

of

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Gee

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alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

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who

wer

e ch

ecke

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com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

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ns

Pre

stan

dard

pra

ctic

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dou

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chec

king

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edic

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ns b

efor

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min

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ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

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n in

cide

nt r

ecor

ds

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7 m

onth

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st

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onth

s

Rasc

hke

et a

l

1998

27

IVQ

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mun

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Con

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s se

en

over

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A co

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stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

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drug

eve

nts

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n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

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n ad

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ug e

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9514

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711

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t es

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mun

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USA

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rms

Erro

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om s

tand

ard

pra

ctic

e

40 h

bef

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and

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rin

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n

Ada

ms

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8911

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QS

511

Clin

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Regi

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m

edic

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SC

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re a

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hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007









































23


23


treatment10
















Objectives



Review method



Types of studies




nurses)







Types of outcomes



Search strategy





















Search phases







Level of evidence


Quality of evidence











measures used






Results
























































Before After P

Spenceret al200530









Ray et al199528










Brownet al199514
















































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

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19

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Beym

er

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l

1990

24

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511

Clin

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R no

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le

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mun

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28

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Clin

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San

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he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007


































Objectives



Review method



Types of studies




nurses)







Types of outcomes



Search strategy





















Search phases







Level of evidence


Quality of evidence











measures used






Results
























































Before After P

Spenceret al200530









Ray et al199528










Brownet al199514
















































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

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d or

der

or

adm

inis

terin

g a

med

icat

ion

ge30

min

bef

ore

or a

fter

th

e sc

hedu

led

time

8 m

onth

s be

fore

and

8

mon

ths a

fter

ch

ange

in

pol

icy

Shah

et

al

19

9446

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

SA

Befo

re a

ndaf

ter

tria

lA

ll cl

inic

al s

taff

Pre

no

rovi

ng p

harm

acis

tPo

st

rovi

ng p

harm

acis

t em

plo

yed

betw

een

8 A

M a

nd

4 PM

C

arry

ing

out

roun

ds

ever

y 0

5 h

on a

ll de

sign

ated

un

its P

erfo

rmin

g m

edic

atio

n or

der

entr

y an

d p

rovi

ding

a

reso

urce

to

nurs

ing

staf

f an

d p

hysi

cian

s D

ealt

with

any

or

derin

g p

robl

ems

Med

icat

ion

inci

dent

s re

por

ted

Erro

rsp

atie

nt d

ays

Dat

a co

llect

ed fo

r 4

year

s be

fore

3

year

s af

ter

inte

rven

tion

Haw

key

et a

l19

9017

IVQ

S no

t es

timab

leC

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Six

hosp

itals

in t

heN

ottin

gham

area

U

K

Obs

erva

tiona

ltr

ial

All

hosp

ital

inp

atie

nts

and

outp

atie

nts

Reco

rdin

g of

eve

ry im

por

tant

in

terv

entio

n m

ade

by

pha

rmac

ists

to

all p

resc

riptio

ns

and

adm

inis

trat

ion

of

med

icin

es f

or a

per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

able

cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007



























Types of outcomes



Search strategy





















Search phases







Level of evidence


Quality of evidence











measures used






Results
























































Before After P

Spenceret al200530









Ray et al199528










Brownet al199514
















































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

2 nu

rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

eeks

1 n

urse

ad

min

iste

ring

med

icat

ions

Con

trol

for

seco

nd 2

3 w

eeks

2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

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QS

811

Clin

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por

tanc

e 1

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Gen

eral

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spita

l M

I U

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trol

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its

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ses

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pro

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se a

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ed to

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r a

spec

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est

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iden

tified

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s in

the

pro

cess

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adm

inis

terin

g m

edic

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ns

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labe

lled

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a

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ther

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ses

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upt

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ber

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Oth

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Inte

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Out

com

es(s

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edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

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t es

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por

tanc

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not

estim

able

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e st

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in t

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SA

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rask

aG

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lein

form

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ter

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Nur

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sta

ff in

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Pre

sta

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be

dsid

e co

mp

uter

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rmin

als

pro

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ntai

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fu

ll cl

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al in

form

atio

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p

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in u

nit

Med

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rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

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ter

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ll RN

s in

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m

edic

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ente

rPr

e a

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qui

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to p

ass

a ye

arly

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N

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med

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erro

rs

rep

orte

d on

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for

ms

reco

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an

8-m

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rors

rep

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or a

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fo

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year

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req

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pol

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et

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19

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611

Clin

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R no

t es

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Gen

eral

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spita

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Reco

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eve

ry im

por

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in

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n m

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pha

rmac

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to

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resc

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ns

and

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inis

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Num

ber

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ber

of w

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in

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ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

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red

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ber

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ases

whe

re

app

reci

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cha

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BCM

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ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

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imp

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nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

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p

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view

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or 7

co

nsec

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docu

men

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of

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men

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rors

per

pat

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per

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w-u

p

afte

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20

0318

III-3

QS

611

Clin

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im

por

tanc

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4R

25

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sing

units

of

a s

tudy

hosp

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MI

USA

Befo

re a

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on 3

nur

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un

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Inte

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Stud

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Out

com

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edLe

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p

BCM

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bar

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adm

inis

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omp

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sici

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y sc

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rele

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Ray

et a

l

1995

28

III-3

QS

711

Clin

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im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

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Befo

re a

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edic

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pat

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s an

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edic

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art

fillin

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s

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art

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nvol

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fol

low

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day

med

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adm

inis

trat

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for

each

pat

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nit

dose

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e p

rodu

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in t

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and

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to

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unit

ever

y 24

h

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stat

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vent

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esta

blis

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for

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edst

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ased

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need

s of

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uni

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he

med

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file

for

each

p

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est

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by t

he

pha

rmac

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d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

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an

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ap

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onso

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nur

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an th

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n re

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imp

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timab

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Four

uni

tsof

a95

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C

USA

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cens

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urse

sPr

e n

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rovi

de m

edic

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n to

ass

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d p

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day

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as

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Num

ber

of m

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ner

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ach

unit

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s

Stud

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Inte

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Out

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sess

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p

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A

bar

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adm

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N

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Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

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units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

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ecki

ng o

fm

edic

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ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

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ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

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n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007





























Search phases







Level of evidence


Quality of evidence











measures used






Results
























































Before After P

Spenceret al200530









Ray et al199528










Brownet al199514
















































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

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een

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A

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all s

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uled

m

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ns t

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less

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to a

dmin

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ked

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st

aff

nurs

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Stat

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l p

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ratio

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us

med

icat

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Th

ese

hand

led

by

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G

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nurs

ing

care

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usu

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verin

g 6

pat

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ch

Obs

erve

d on

ly w

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pro

vidi

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edic

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nSt

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cond

ucte

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tane

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y at

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wo

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Med

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nitie

s)

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for

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R no

t es

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le

Thre

e he

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cilit

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USA

bull

Teac

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ho

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Tert

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car

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e he

alth

care

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Rand

omis

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ial

69 R

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ses

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f 4

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Con

trol

(n

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nurs

es w

ere

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o up

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the

ir ca

lcul

atio

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ills

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ook

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ann

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l

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19

III-1

QS

711

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tanc

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t es

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mun

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bull Pa

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lem

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2003

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er

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l

1990

24

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QS

511

Clin

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imp

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nce

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able

R no

t es

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le

Com

mun

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nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007


























Results
























































Before After P

Spenceret al200530









Ray et al199528










Brownet al199514
















































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

2 nu

rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

eeks

1 n

urse

ad

min

iste

ring

med

icat

ions

Con

trol

for

seco

nd 2

3 w

eeks

2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

edic

atio

nM

edic

atio

n ch

art

not

sign

ed

23 w

eeks

fo

r ea

ch

segm

ent

46 w

eeks

in t

otal

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Con

trol

led

tria

ls

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Kucu

kars

lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

al p

harm

acis

ts a

ndin

pat

ient

s ad

mitt

ed t

o 1

of2

inte

rnal

med

icin

e un

its

Con

trol

gro

up

n =

79M

ean

age

56

5 plusmn

196

yea

rs36

mal

e 4

3 fe

mal

eSt

udy

grou

pn

= 86

Mea

n ag

e 5

39

plusmn 19

8 y

ears

36 m

ale

50

fem

ale

Con

trol

p

atie

nts

in t

his

grou

p r

ecei

ved

stan

dard

ca

re f

rom

pha

rmac

ists

with

a

ratio

of

1 p

harm

acis

t fo

r ev

ery

30 p

atie

nts

Prev

enta

ble

drug

eve

nts

Even

ts1

000

pat

ient

day

sEv

ents

tot

al p

atie

nts

87 d

ays

fro

m5

Sep

tem

ber

to30

Nov

embe

r

Stud

y 2

clin

ical

pha

rmac

ists

as

sign

ed t

o p

atie

nt c

are

at

beds

ide

incl

udin

g ro

unds

do

cum

enta

tion

of

pha

rmac

othe

rap

y hi

stor

y an

d p

rovi

ding

dis

char

ge

coun

selli

ng

Pap

e

2003

25III

-2Q

S 7

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Med

ical

su

rgic

al u

nit

of a

cute

car

eho

spita

l TX

U

SA

Con

trol

led

tria

lC

onve

nien

ce s

amp

le o

f re

gist

ered

nur

ses

on a

m

edic

al s

urgi

cal u

nit

of 3

0 p

atie

nts

Con

trol

to

tal o

f 8

cycl

es

Nur

ses

used

cus

tom

ary

med

icat

ion

adm

inis

trat

ion

pro

cedu

res

Focu

sed

prot

ocol

to

tal o

f 8

cycl

es

A lsquo

spec

ial n

urse

rsquo de

sign

ated

and

sta

ff as

ked

to n

ot in

terr

upt

or d

istr

act

the

spec

ial n

urse

unl

ess

rela

ted

to m

edic

atio

ns

bein

g ad

min

iste

red

Med

safe

pro

toco

l to

tal o

f 8

cycl

es

Nur

se a

dmin

iste

ring

med

icat

ions

ask

ed to

wea

r a

spec

ial v

est

that

iden

tified

th

em a

s in

the

pro

cess

of

adm

inis

terin

g m

edic

atio

ns

Vest

labe

lled

with

a

lsquoMed

safe

Nur

se

do n

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tate

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ig

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er

et a

l

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24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

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m

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ass

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erro

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ms

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for

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fo

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III-3

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Clin

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t es

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eral

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view

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por

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inis

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et a

l

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711

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por

tanc

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4R

35

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vers

ity

hosp

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San

Die

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ant

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fol

low

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day

med

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adm

inis

trat

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for

each

pat

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e p

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in t

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harm

acy

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ered

to

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unit

ever

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h

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stat

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esta

blis

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each

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ased

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need

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uni

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he

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file

for

each

p

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est

ablis

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he

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wnl

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ntra

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in r

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time

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app

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imp

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Four

uni

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a95

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l N

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USA

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ndaf

ter

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sPr

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rovi

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n to

al

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an

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20

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QS

711

Clin

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imp

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t es

timab

le

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pat

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units

of

hosp

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ustr

alia

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re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

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who

wer

e ch

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com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

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ns

Pre

stan

dard

pra

ctic

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dou

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chec

king

of m

edic

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ns b

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min

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heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

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n in

cide

nt r

ecor

ds

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7 m

onth

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st

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onth

s

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hke

et a

l

1998

27

IVQ

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mun

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ser

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Con

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s se

en

over

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A co

mpu

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stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

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drug

eve

nts

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n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

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n ad

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ug e

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9514

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QS

711

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imp

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nce

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R no

t es

timab

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mun

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spita

l N

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USA

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rms

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n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

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8911

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QS

511

Clin

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R no

t es

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le

Regi

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m

edic

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SC

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re a

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Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007

























































Before After P

Spenceret al200530









Ray et al199528










Brownet al199514
















































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

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tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

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dy

nam

ics

of c

hang

e in

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pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

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pro

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asks

to

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Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

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sess

men

t an

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ustr

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Con

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War

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C

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or fi

rst

and

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nurs

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A

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hart

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an

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er

Med

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ber

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pen

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Erro

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Med

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Dos

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Stud

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Inte

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Kucu

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lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

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harm

acis

ts a

ndin

pat

ient

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rnal

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icin

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its

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trol

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n =

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pn

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n ag

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ears

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Con

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p

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r

Stud

y 2

clin

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as

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o p

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at

beds

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ge

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25III

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S 7

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linic

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nce

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Med

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nit

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lC

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ce s

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le o

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ses

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m

edic

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nit

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trol

to

tal o

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cycl

es

Nur

ses

used

cus

tom

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med

icat

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adm

inis

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pro

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es

A lsquo

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sign

ated

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ff as

ked

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ess

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ted

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edic

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safe

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Nur

se a

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icat

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ask

ed to

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r a

spec

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est

that

iden

tified

th

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s in

the

pro

cess

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adm

inis

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edic

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ns

Vest

labe

lled

with

a

lsquoMed

safe

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se

do n

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dist

urbrsquo

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ther

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ses

inst

ruct

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upt

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se a

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red

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cum

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edic

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com

ple

ted

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otal

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les

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entio

n

QS

qua

lity

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leva

nce



Oth

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esig

ns

Stud

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vel o

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pp

rais

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scor

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Inte

rven

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Out

com

es(s

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sess

edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

al im

por

tanc

eno

t es

timab

leR

not

estim

able

Thre

e st

ates

in t

he U

SA

Neb

rask

aG

eorg

ia

Penn

sylv

ania

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lein

form

atio

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kely

a b

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ean

d af

ter

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l

Nur

sing

sta

ff in

nurs

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units

Pre

sta

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re

Post

be

dsid

e co

mp

uter

te

rmin

als

pro

vide

d co

ntai

ning

fu

ll cl

inic

al in

form

atio

n of

p

atie

nts

in u

nit

Med

icat

ion

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rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

lA

ll RN

s in

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m

edic

al c

ente

rPr

e a

ll RN

s re

qui

red

to p

ass

a ye

arly

med

icat

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exam

inat

ion

N

umbe

r of

med

icat

ion

erro

rs

rep

orte

d on

inci

dent

for

ms

reco

rded

for

an

8-m

onth

p

erio

dPo

st

no m

edic

atio

n ex

amin

atio

n er

rors

rep

orte

d on

in

cide

nt f

orm

s re

cord

ed f

or a

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mon

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the

fo

llow

ing

year

aft

er

req

uire

men

t fo

r m

edic

atio

n ex

amin

atio

ns a

bolis

hed

Med

icat

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r t

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th p

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med

icat

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r w

as

defin

ed a

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rong

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n or

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e or

rat

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f in

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med

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min

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e sc

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s be

fore

and

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mon

ths a

fter

ch

ange

in

pol

icy

Shah

et

al

19

9446

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

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Med

icat

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ted

Erro

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Dat

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llect

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year

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fore

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l19

9017

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S no

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Six

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K

Obs

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ial

All

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Reco

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por

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n m

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to

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resc

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ns

and

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inis

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es f

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per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

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cha

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wer

e m

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28 d

ays

BCM

A

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code

med

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ion

adm

inis

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ion

CPO

E c

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phy

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an o

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rele

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Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

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imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

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Befo

re a

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ter

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hen

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rror

id

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mat

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nit

per

mon

th w

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ach

sele

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p

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char

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view

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co

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utiv

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docu

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of

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rors

per

pat

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per

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p

afte

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tlie

20

0318

III-3

QS

611

Clin

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im

por

tanc

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4R

25

Nur

sing

units

of

a s

tudy

hosp

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MI

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Befo

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thor

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it

Con

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st

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re

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tim

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whe

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Inte

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min

)

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here

insu

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min

afte

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ood

gluc

ose

test

(in

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1-m

onth

pre

inte

rven

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data

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llect

ion

per

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follo

wed

by

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mon

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1-m

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data

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np

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d

Stud

yLe

vel o

f ev

iden

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pp

rais

al

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catio

nSt

udy

desi

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udy

pop

ulat

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Inte

rven

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Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

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y Q

S q

ualit

y sc

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rele

vanc

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ed n

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Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

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ener

al m

edic

al

pat

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s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

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n ca

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e In

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fol

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day

med

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adm

inis

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for

each

pat

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e p

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in t

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acy

and

deliv

ered

to

the

unit

ever

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h

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stat

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an in

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ory

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esta

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edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007






























































incidence



























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

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ook

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19

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s tim

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tate

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ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

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imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

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m

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ms

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cide

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fore

and

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mon

ths a

fter

ch

ange

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pol

icy

Shah

et

al

19

9446

III-3

QS

611

Clin

ical

imp

orta

nce

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estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

SA

Befo

re a

ndaf

ter

tria

lA

ll cl

inic

al s

taff

Pre

no

rovi

ng p

harm

acis

tPo

st

rovi

ng p

harm

acis

t em

plo

yed

betw

een

8 A

M a

nd

4 PM

C

arry

ing

out

roun

ds

ever

y 0

5 h

on a

ll de

sign

ated

un

its P

erfo

rmin

g m

edic

atio

n or

der

entr

y an

d p

rovi

ding

a

reso

urce

to

nurs

ing

staf

f an

d p

hysi

cian

s D

ealt

with

any

or

derin

g p

robl

ems

Med

icat

ion

inci

dent

s re

por

ted

Erro

rsp

atie

nt d

ays

Dat

a co

llect

ed fo

r 4

year

s be

fore

3

year

s af

ter

inte

rven

tion

Haw

key

et a

l19

9017

IVQ

S no

t es

timab

leC

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Six

hosp

itals

in t

heN

ottin

gham

area

U

K

Obs

erva

tiona

ltr

ial

All

hosp

ital

inp

atie

nts

and

outp

atie

nts

Reco

rdin

g of

eve

ry im

por

tant

in

terv

entio

n m

ade

by

pha

rmac

ists

to

all p

resc

riptio

ns

and

adm

inis

trat

ion

of

med

icin

es f

or a

per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

able

cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007
























Pharmacists














Mean SD Mean SD



67 registerednurses















III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

2 nu

rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

eeks

1 n

urse

ad

min

iste

ring

med

icat

ions

Con

trol

for

seco

nd 2

3 w

eeks

2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

edic

atio

nM

edic

atio

n ch

art

not

sign

ed

23 w

eeks

fo

r ea

ch

segm

ent

46 w

eeks

in t

otal

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

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Inte

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Out

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Med

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of

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s tim

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ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

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ms

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Clin

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por

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BCM

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29

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por

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et a

l

1995

28

III-3

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711

Clin

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por

tanc

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35

Uni

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hosp

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San

Die

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CA

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med

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unit

ever

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h

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file

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an

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l

2002

20

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QS

711

Clin

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imp

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R no

t es

timab

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Adu

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Der

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n in

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1998

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Con

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nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007
































III-2Control study





Rounding team only





Shah et al199446







NA





Hawkeyet al199017





NA not applicable



Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

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Clin

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rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Nursing care models
























IIRCT






9125792 (157)6515792 (112)2815792 (49)

5453661 (149)2533661 (69)3063661 (84)

lt084lt015lt006
























Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

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nSt

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desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

al im

por

tanc

eno

t es

timab

leR

not

estim

able

Thre

e st

ates

in t

he U

SA

Neb

rask

aG

eorg

ia

Penn

sylv

ania

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lein

form

atio

nLi

kely

a b

efor

ean

d af

ter

tria

l

Nur

sing

sta

ff in

nurs

ing

units

Pre

sta

ndar

d ca

re

Post

be

dsid

e co

mp

uter

te

rmin

als

pro

vide

d co

ntai

ning

fu

ll cl

inic

al in

form

atio

n of

p

atie

nts

in u

nit

Med

icat

ion

erro

rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

lA

ll RN

s in

the

m

edic

al c

ente

rPr

e a

ll RN

s re

qui

red

to p

ass

a ye

arly

med

icat

ion

exam

inat

ion

N

umbe

r of

med

icat

ion

erro

rs

rep

orte

d on

inci

dent

for

ms

reco

rded

for

an

8-m

onth

p

erio

dPo

st

no m

edic

atio

n ex

amin

atio

n er

rors

rep

orte

d on

in

cide

nt f

orm

s re

cord

ed f

or a

n 8-

mon

th p

erio

d in

the

fo

llow

ing

year

aft

er

req

uire

men

t fo

r m

edic

atio

n ex

amin

atio

ns a

bolis

hed

Med

icat

ion

erro

r t

otal

erro

rs8

-mon

th p

erio

dA

med

icat

ion

erro

r w

as

defin

ed a

s w

rong

m

edic

atio

n or

ext

ra d

ose

wro

ng p

atie

nt

rout

e or

rat

e o

f in

trav

enou

s flu

id

omitt

ing

a m

edic

atio

np

rovi

ding

a m

edic

atio

nfr

om a

n ex

pire

d or

der

or

adm

inis

terin

g a

med

icat

ion

ge30

min

bef

ore

or a

fter

th

e sc

hedu

led

time

8 m

onth

s be

fore

and

8

mon

ths a

fter

ch

ange

in

pol

icy

Shah

et

al

19

9446

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

SA

Befo

re a

ndaf

ter

tria

lA

ll cl

inic

al s

taff

Pre

no

rovi

ng p

harm

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tPo

st

rovi

ng p

harm

acis

t em

plo

yed

betw

een

8 A

M a

nd

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C

arry

ing

out

roun

ds

ever

y 0

5 h

on a

ll de

sign

ated

un

its P

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rmin

g m

edic

atio

n or

der

entr

y an

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rovi

ding

a

reso

urce

to

nurs

ing

staf

f an

d p

hysi

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any

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Med

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dent

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por

ted

Erro

rsp

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nt d

ays

Dat

a co

llect

ed fo

r 4

year

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fore

3

year

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ter

inte

rven

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key

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l19

9017

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t es

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por

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e no

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Six

hosp

itals

in t

heN

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area

U

K

Obs

erva

tiona

ltr

ial

All

hosp

ital

inp

atie

nts

and

outp

atie

nts

Reco

rdin

g of

eve

ry im

por

tant

in

terv

entio

n m

ade

by

pha

rmac

ists

to

all p

resc

riptio

ns

and

adm

inis

trat

ion

of

med

icin

es f

or a

per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

able

cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

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E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



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ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

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sist

s of

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aff

nurs

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urse

man

ager

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acis

tsIn

form

atio

n sy

stem

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naly

sts

Risk

man

ager

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sing

edu

cato

rC

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ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

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ith s

taff

with

re

gula

r lsquoH

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ll nu

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pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

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ardi

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rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

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e im

por

tanc

e of

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tim

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of

bloo

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term

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d th

e su

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min

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lin

Prov

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ll un

its to

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low

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side

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ting

Tim

e an

d do

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otat

ions

re

mov

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rom

MA

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rcin

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rse

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inis

terin

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e in

sulin

to

writ

e in

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tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

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vel o

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ceA

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pop

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ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

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nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

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n is

the

n re

leas

ed

from

the

med

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ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

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wee

ks

Post

6

wee

ks

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n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

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catio

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desi

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udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

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rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

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lltim

e

Con

trol

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gula

r ca

re 4

0 h

of

obse

rvat

ion

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ay a

nd

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shift

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k da

ys a

nd

1 da

y on

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wee

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In

terv

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n b

edsi

de t

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sy

stem

Th

e be

dsid

e te

rmin

al

syst

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rder

ent

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nurs

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care

pla

nnin

g

labo

rato

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nd X

-ray

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ne h

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p

orta

ble

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ea

ch p

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ce

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l nur

sing

sta

tion

The

se

term

inal

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mm

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ate

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a

term

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ser

ver l

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ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

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k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

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erro

r ra

te

mea

sure

d by

med

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ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

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dr

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ans

p

harm

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ts

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Pre

14-

day

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writ

ten

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Re

qui

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man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

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nts

and

insu

lin R

esp

irato

ry th

erap

y dr

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t lo

cate

d on

an

MA

R N

o p

roce

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to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

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sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

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pha

rmac

y

Med

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rs

Nur

ses

on t

he 1

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to

7 A

Msh

ift w

ould

che

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e or

der

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nst

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desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007











































Mean(of 8 cycles)


Pape200325





145 (72 218)Daggerlt0001

0001




2 nurses 1 nurse

Kruseet al199221



Geriatric patients














































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

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19

9221

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811

Clin

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nce

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Thre

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2003

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QS

811

Clin

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por

tanc

e 1

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25

Gen

eral

ho

spita

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SA

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pro

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qua

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leva

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Oth

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Inte

rven

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Out

com

es(s

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edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

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por

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eno

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timab

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not

estim

able

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e st

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in t

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SA

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rask

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form

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Nur

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sta

ff in

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be

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pro

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p

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Med

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s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

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ter

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m

edic

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ente

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e a

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qui

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to p

ass

a ye

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erro

rs

rep

orte

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for

ms

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for

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8-m

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p

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st

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rors

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fo

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pol

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et

al

19

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QS

611

Clin

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R no

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timab

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Gen

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por

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per

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Num

ber

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in

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ns

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ber

of c

ases

whe

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pre

scrip

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ber

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whe

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app

reci

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cha

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BCM

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ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

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imp

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estim

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R no

t es

timab

le

Gen

eral

ho

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l LA

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QS

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por

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1995

28

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Clin

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35

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San

Die

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CA

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sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007
































































Control Treatment

Heatlie200318



2 142190 (747) 163192 (849) 19 (11 32)3 113131 (863) 110120 (917) 18 (08 40)

R 25 Pooled 361497 (726) 405497 (815) 22 (16 30)




P

Control Treatment


Heatlie200318

III-2Control study


Nurses on3 units









Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

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Nur

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Med

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nurs

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fety

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G

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care

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usu

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Obs

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Teac

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car

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alth

care

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ency

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ook

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lem

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ses

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l

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QS

511

Clin

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le

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mun

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cide

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611

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e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007

























Discussion












Effectiveness































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

2 nu

rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

eeks

1 n

urse

ad

min

iste

ring

med

icat

ions

Con

trol

for

seco

nd 2

3 w

eeks

2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

edic

atio

nM

edic

atio

n ch

art

not

sign

ed

23 w

eeks

fo

r ea

ch

segm

ent

46 w

eeks

in t

otal

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Con

trol

led

tria

ls

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Kucu

kars

lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

al p

harm

acis

ts a

ndin

pat

ient

s ad

mitt

ed t

o 1

of2

inte

rnal

med

icin

e un

its

Con

trol

gro

up

n =

79M

ean

age

56

5 plusmn

196

yea

rs36

mal

e 4

3 fe

mal

eSt

udy

grou

pn

= 86

Mea

n ag

e 5

39

plusmn 19

8 y

ears

36 m

ale

50

fem

ale

Con

trol

p

atie

nts

in t

his

grou

p r

ecei

ved

stan

dard

ca

re f

rom

pha

rmac

ists

with

a

ratio

of

1 p

harm

acis

t fo

r ev

ery

30 p

atie

nts

Prev

enta

ble

drug

eve

nts

Even

ts1

000

pat

ient

day

sEv

ents

tot

al p

atie

nts

87 d

ays

fro

m5

Sep

tem

ber

to30

Nov

embe

r

Stud

y 2

clin

ical

pha

rmac

ists

as

sign

ed t

o p

atie

nt c

are

at

beds

ide

incl

udin

g ro

unds

do

cum

enta

tion

of

pha

rmac

othe

rap

y hi

stor

y an

d p

rovi

ding

dis

char

ge

coun

selli

ng

Pap

e

2003

25III

-2Q

S 7

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Med

ical

su

rgic

al u

nit

of a

cute

car

eho

spita

l TX

U

SA

Con

trol

led

tria

lC

onve

nien

ce s

amp

le o

f re

gist

ered

nur

ses

on a

m

edic

al s

urgi

cal u

nit

of 3

0 p

atie

nts

Con

trol

to

tal o

f 8

cycl

es

Nur

ses

used

cus

tom

ary

med

icat

ion

adm

inis

trat

ion

pro

cedu

res

Focu

sed

prot

ocol

to

tal o

f 8

cycl

es

A lsquo

spec

ial n

urse

rsquo de

sign

ated

and

sta

ff as

ked

to n

ot in

terr

upt

or d

istr

act

the

spec

ial n

urse

unl

ess

rela

ted

to m

edic

atio

ns

bein

g ad

min

iste

red

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safe

pro

toco

l to

tal o

f 8

cycl

es

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se a

dmin

iste

ring

med

icat

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ask

ed to

wea

r a

spec

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est

that

iden

tified

th

em a

s in

the

pro

cess

of

adm

inis

terin

g m

edic

atio

ns

Vest

labe

lled

with

a

lsquoMed

safe

Nur

se

do n

ot

dist

urbrsquo

O

ther

nur

ses

inst

ruct

ed t

o no

t in

terr

upt

Med

safe

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se a

nd t

o in

terc

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her

dist

ract

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Num

ber

of d

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by n

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d as

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g w

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the

nurs

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itiat

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dmin

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atio

nof

all

assi

gned

pat

ient

med

icat

ions

and

end

whe

ndo

cum

enta

tion

of

adm

inis

tere

d m

edic

atio

nsis

com

ple

ted

24 t

otal

cyc

les

8 cy

cles

per

in

terv

entio

n

QS

qua

lity

scor

e R

re

leva

nce



Oth

er e

xper

imen

tal d

esig

ns

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

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catio

nSt

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desi

gnSt

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pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

al im

por

tanc

eno

t es

timab

leR

not

estim

able

Thre

e st

ates

in t

he U

SA

Neb

rask

aG

eorg

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Penn

sylv

ania

Litt

lein

form

atio

nLi

kely

a b

efor

ean

d af

ter

tria

l

Nur

sing

sta

ff in

nurs

ing

units

Pre

sta

ndar

d ca

re

Post

be

dsid

e co

mp

uter

te

rmin

als

pro

vide

d co

ntai

ning

fu

ll cl

inic

al in

form

atio

n of

p

atie

nts

in u

nit

Med

icat

ion

erro

rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

lA

ll RN

s in

the

m

edic

al c

ente

rPr

e a

ll RN

s re

qui

red

to p

ass

a ye

arly

med

icat

ion

exam

inat

ion

N

umbe

r of

med

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ion

erro

rs

rep

orte

d on

inci

dent

for

ms

reco

rded

for

an

8-m

onth

p

erio

dPo

st

no m

edic

atio

n ex

amin

atio

n er

rors

rep

orte

d on

in

cide

nt f

orm

s re

cord

ed f

or a

n 8-

mon

th p

erio

d in

the

fo

llow

ing

year

aft

er

req

uire

men

t fo

r m

edic

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n ex

amin

atio

ns a

bolis

hed

Med

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erro

r t

otal

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th p

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med

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ion

erro

r w

as

defin

ed a

s w

rong

m

edic

atio

n or

ext

ra d

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ng p

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rout

e or

rat

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f in

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s flu

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edic

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rovi

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om a

n ex

pire

d or

der

or

adm

inis

terin

g a

med

icat

ion

ge30

min

bef

ore

or a

fter

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e sc

hedu

led

time

8 m

onth

s be

fore

and

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fter

ch

ange

in

pol

icy

Shah

et

al

19

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611

Clin

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imp

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able

R no

t es

timab

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Gen

eral

ho

spita

l N

J U

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Befo

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Dat

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Reco

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eve

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por

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pha

rmac

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Num

ber

of in

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ns

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ber

of w

arra

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in

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entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

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cha

nges

wer

e m

ade

28 d

ays

BCM

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bar

code

med

icat

ion

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inis

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ion

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2000

29

III-3

QS

611

Clin

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imp

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nce

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estim

able

R no

t es

timab

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Gen

eral

ho

spita

l LA

U

SA

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view

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nsec

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por

tanc

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Inte

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data

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llect

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follo

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Stud

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vel o

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Inte

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Out

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w-u

p

BCM

A

bar

code

med

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inis

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et a

l

1995

28

III-3

QS

711

Clin

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im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

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edic

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chni

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s

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trol

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art

fill

syst

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nvol

ves

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edic

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n ca

sset

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hang

e In

ant

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n of

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fol

low

ing

day

med

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adm

inis

trat

ion

for

each

pat

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nit

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e p

rodu

ced

in t

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harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

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esta

blis

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each

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ased

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need

s of

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uni

t T

he

med

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file

for

each

p

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nt is

est

ablis

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pha

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wnl

oade

d to

th

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ntra

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min

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in r

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time

ie

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app

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imp

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Four

uni

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an

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2002

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Clin

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R no

t es

timab

le

Adu

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units

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ndaf

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ce

sam

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wer

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ent

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sing

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ng o

fm

edic

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ns

Pre

stan

dard

pra

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king

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edic

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ns b

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min

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per

form

ed

Rep

orte

d m

edic

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n er

rors

Der

ived

fro

m m

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n in

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nt r

ecor

ds

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l

1998

27

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mun

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Con

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A co

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was

cr

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arge

ted

37 d

rug-

spec

ific

adve

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drug

eve

nts

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n al

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gen

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ituat

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w

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risk

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n ad

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711

Clin

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imp

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nce

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R no

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Com

mun

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USA

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iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007


















































Pharmacists



Nursing care models









Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

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811

Clin

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nce

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811

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por

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Inte

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ngth

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follo

w-u

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Cer

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por

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in t

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SA

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rask

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Nur

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sta

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form

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Med

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s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

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e a

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ms

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pol

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et

al

19

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Clin

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R no

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Gen

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Reco

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por

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Num

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in

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ns

Num

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of c

ases

whe

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ber

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whe

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cha

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ubhu

tan

d Jo

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2000

29

III-3

QS

611

Clin

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R no

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Gen

eral

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por

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Inte

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Out

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1995

28

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Clin

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hosp

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San

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CA

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he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Recommendations






Pharmacists


Nursing care models










References



































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

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nce

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nt d

ays

Dat

a co

llect

ed fo

r 4

year

s be

fore

3

year

s af

ter

inte

rven

tion

Haw

key

et a

l19

9017

IVQ

S no

t es

timab

leC

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Six

hosp

itals

in t

heN

ottin

gham

area

U

K

Obs

erva

tiona

ltr

ial

All

hosp

ital

inp

atie

nts

and

outp

atie

nts

Reco

rdin

g of

eve

ry im

por

tant

in

terv

entio

n m

ade

by

pha

rmac

ists

to

all p

resc

riptio

ns

and

adm

inis

trat

ion

of

med

icin

es f

or a

per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

able

cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007
































































Appendix I






Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

Kaus

hal

et a

l

2003

9

IRe

view

obj

ectiv

eRe

view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

icat

ion

safe

ty

Sour

ces

used

Se

elsquoD

atab

ases

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Stud

ies

eval

uatin

gC

POE

obse

rvat

iona

lst

udie

s or

abo

ve

surr

ogat

e cl

inic

alou

tcom

es o

r be

tter

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

yde

sign

and

out

com

em

easu

res

Dat

a ex

trac

tion

Bibl

iogr

aphi

c de

tails

st

udy

desc

riptio

nde

sign

ou

tcom

esan

d re

sults

D

ata

synt

hesi

sN

arra

tive

sum

mar

ies

Bost

on

MA

U

SA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull St

udie

s ev

alua

ting

CPO

E w

ith C

DSS

or

CD

SS a

lone

bull

Obs

erva

tiona

l stu

dies

with

co

ntro

ls

cont

rolle

d tr

ials

an

d ra

ndom

ised

con

trol

led

tria

ls

bull Su

rrog

ate

clin

ical

out

com

es

clin

ical

out

com

es

Dat

abas

e se

arch

and

re

trie

val

Two-

per

son

dete

rmin

atio

n of

stu

dy

qua

lity

usin

gp

rosp

ectiv

ely

dete

rmin

ed e

lem

ents

of

qua

lity

Stud

ies

grou

ped

into

two

cate

gorie

s C

POE

with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

the

pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

itorin

g m

edic

atio

ns

NA

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

rsquoDat

abas

es

sear

ched

rsquo co

lum

nIn

clus

ion

crite

ria

Obs

erva

tiona

l stu

dy

desi

gns

or h

ighe

r Su

rrog

ate

or c

linic

al

outc

omes

Q

ualit

y as

sess

ed b

yH

iera

rchy

of

stud

y de

sign

and

out

com

e m

easu

res

Dat

a ex

trac

tion

10 e

xtra

ctio

n el

emen

ts1

Bib

liogr

aphi

c in

form

atio

n2

Lev

el o

f st

udy

desi

gn3

Des

crip

tion

of

inte

rven

tion

4 S

tudy

pop

ulat

ion

5 O

utco

me

6 A

nd le

vel o

f ou

tcom

e7

Mai

n re

sults

8 A

dver

se e

vent

s9

Cos

ts10

In

form

atio

n on

im

ple

men

tatio

nD

ata

synt

hesi

sN

arra

tive

sum

mar

ies

San

Fran

cisc

oC

A

USA

bull M

EDLI

NE

bull C

ochr

ane

Libr

ary

bull C

INA

HL

bull Ps

ycIN

FObull

INSP

ECbull

ABI

IN

FORM

bull In

stitu

te f

or

Scie

ntifi

c In

form

atio

nrsquos

Scie

nce

Cita

tion

Inde

xbull

Soci

al

Scie

nces

C

itatio

n In

dex

bull A

ny p

ract

ice

that

can

be

app

lied

to t

he h

osp

ital s

ettin

g or

to

the

inp

atie

nto

utp

atie

nt in

terf

ace

AN

D

can

be a

pp

lied

to a

bro

ad r

ange

of

heal

thca

re c

ondi

tions

or

pro

cedu

res

bullStu

dy d

esig

n of

at

leas

t ob

serv

atio

nal s

tudy

with

con

trol

s or

abo

ve

bullOut

com

e m

easu

re m

ust

be a

t le

ast

surr

ogat

e or

clin

ical

Mor

bidi

tyM

orta

lity

Adv

erse

eve

nts

Obs

erve

d er

rors

NA

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

esas

sess

edLe

ngth

of

follo

w-u

p

CD

SS

clin

ical

dec

isio

n su

pp

ort

syst

em

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y N

A

not

app

licab

le



Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

2 nu

rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

eeks

1 n

urse

ad

min

iste

ring

med

icat

ions

Con

trol

for

seco

nd 2

3 w

eeks

2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

edic

atio

nM

edic

atio

n ch

art

not

sign

ed

23 w

eeks

fo

r ea

ch

segm

ent

46 w

eeks

in t

otal

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Con

trol

led

tria

ls

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Kucu

kars

lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

al p

harm

acis

ts a

ndin

pat

ient

s ad

mitt

ed t

o 1

of2

inte

rnal

med

icin

e un

its

Con

trol

gro

up

n =

79M

ean

age

56

5 plusmn

196

yea

rs36

mal

e 4

3 fe

mal

eSt

udy

grou

pn

= 86

Mea

n ag

e 5

39

plusmn 19

8 y

ears

36 m

ale

50

fem

ale

Con

trol

p

atie

nts

in t

his

grou

p r

ecei

ved

stan

dard

ca

re f

rom

pha

rmac

ists

with

a

ratio

of

1 p

harm

acis

t fo

r ev

ery

30 p

atie

nts

Prev

enta

ble

drug

eve

nts

Even

ts1

000

pat

ient

day

sEv

ents

tot

al p

atie

nts

87 d

ays

fro

m5

Sep

tem

ber

to30

Nov

embe

r

Stud

y 2

clin

ical

pha

rmac

ists

as

sign

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Inte

rven

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Out

com

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ngth

of

follo

w-u

p

Cer

ne

1989

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S no

t es

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por

tanc

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not

estim

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rask

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pro

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fu

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Med

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s

of

pre

viou

s tim

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erio

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ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

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rs

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ms

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Clin

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Gen

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por

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cha

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BCM

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Clin

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R no

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Gen

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l

1995

28

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35

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hosp

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San

Die

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CA

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adm

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for

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pat

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unit

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h

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uni

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he

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file

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p

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est

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wnl

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th

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ntra

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an

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2002

20

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QS

711

Clin

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R no

t es

timab

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fm

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Der

ived

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m m

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n in

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ecor

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Con

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A co

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w

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Clin

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mun

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es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Ap

pen

dix

II

Stu

die

s in

clu

ded

in

th

e re

view

Syst

emat

ic r

evie

ws

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al s

core

Loca

tion

Dat

abas

es

sear

ched

Incl

usio

n cr

iteria

Met

hod

Out

com

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ngth

of

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p

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hal

et a

l

2003

9

IRe

view

obj

ectiv

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view

the

cum

ulat

ive

evid

ence

on

the

effe

cts

of C

POE

and

CD

SSon

med

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safe

ty

Sour

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used

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ases

sear

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lum

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clus

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Stud

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Q

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sess

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and

out

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Dat

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trac

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Bibl

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cont

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Two-

per

son

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stu

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qua

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rosp

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dete

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lem

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of

qua

lity

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ies

grou

ped

into

two

cate

gorie

s C

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with

CD

SS

orC

DSS

alo

ne

Med

icat

ion

erro

rs

Defi

ned

as e

rror

sin

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pro

cess

of

orde

ring

tr

ansc

ribin

g

disp

ensi

ng

adm

inis

terin

g or

mon

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edic

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ns

NA

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clin

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al

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orta

nce

not

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R 2

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Two

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spita

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th

e U

SA

Cal

iforn

ia

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Ohi

o

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tre

rand

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ed

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rolle

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with

at

leas

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year

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e ca

re

nurs

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erie

nce

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inim

um o

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mon

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ls

Nur

ses

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n nu

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or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

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8-

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edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

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8 p

atie

nts

each

A

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iste

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all s

ched

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m

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atio

ns t

o th

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less

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ble

to a

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icat

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suc

h as

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ked

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aff

nurs

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it D

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inis

ter

Stat

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by

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f nu

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G

ener

al n

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s p

rovi

ded

nurs

ing

care

in

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usu

al m

anne

r co

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g 6

pat

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s ea

ch

Obs

erve

d on

ly w

hen

pro

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edic

atio

nSt

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cond

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mul

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itals

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ks

5 da

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er w

eek

excl

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e w

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Med

icat

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r ra

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opp

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s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

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ebull

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pre

par

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Adm

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tech

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12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

Soft

war

e

Cha

pel

Hill

N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

udy

wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

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l

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19

III-1

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lem

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s tim

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tate

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ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

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imp

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nce

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R no

t es

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le

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mun

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Ray

et a

l

1995

28

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711

Clin

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por

tanc

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Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Shoj

ania

et

al

M

orta

lity

2001

6

IRe

view

obj

ectiv

eId

entifi

catio

n an

d ev

alua

tion

of p

atie

nt

safe

ty p

ract

ices

So

urce

s us

ed

See

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abas

es

sear

ched

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lum

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clus

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crite

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erva

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dy

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Q

ualit

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sess

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stud

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sign

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e m

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Dat

a ex

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10 e

xtra

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liogr

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form

atio

n2

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inte

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bull M

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Obs

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Stud

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vel o

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rais

al s

core

Loca

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Dat

abas

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sear

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Incl

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Met

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Out

com

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sess

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clin

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dec

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Rand

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ontr

ol t

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Stud

yLe

vel o

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catio

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Inte

rven

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Out

com

es a

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Leng

th o

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Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

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ia

and

Ohi

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Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

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RNs

with

at

leas

t 1

year

of

acut

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re

nurs

ing

exp

erie

nce

and

a m

inim

um o

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ls

Nur

ses

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as

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er

a m

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gen

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nur

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Med

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nurs

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edic

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fety

pro

gram

N

urse

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een

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nd 1

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each

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all s

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m

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ns t

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eir

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less

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to a

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lin i

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ked

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rom

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aff

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Stat

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ratio

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us

med

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ions

Th

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hand

led

by

unm

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staf

f nu

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G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

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s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

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nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

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wo

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Med

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Thre

e he

alth

care

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cilit

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in

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USA

bull

Teac

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ho

spita

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Tert

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car

eho

spita

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Hom

e he

alth

care

ag

ency

Rand

omis

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cont

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d tr

ial

69 R

Ns

Nur

ses

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Con

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(n

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nurs

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ere

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the

ir ca

lcul

atio

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ills

in a

ny m

anne

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her

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mal

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pute

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stru

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ook

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urse

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ann

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l

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19

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711

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por

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t es

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bull Pa

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lem

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test

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inci

dent

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dure

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clea

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Clin

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tal o

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ses

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adm

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l

1990

24

III-3

QS

511

Clin

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imp

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nce

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R no

t es

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le

Com

mun

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cide

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whe

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scrip

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sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

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Inte

rven

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Out

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edLe

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of

follo

w-u

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A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Rand

omis

ed c

ontr

ol t

rials

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

Gre

engo

ldet

al

20

0316

IIQ

S 8

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Two

univ

ersi

tyho

spita

ls in

th

e U

SA

Cal

iforn

ia

and

Ohi

o

Mul

ticen

tre

rand

omis

ed

cont

rolle

d tr

ial

RNs

with

at

leas

t 1

year

of

acut

e ca

re

nurs

ing

exp

erie

nce

and

a m

inim

um o

f 6-

mon

th f

ull-t

ime

emp

loym

ent

at

resp

ectiv

e ho

spita

ls

Nur

ses

rand

omis

ed t

o a

role

as

eith

er

a m

edic

atio

n nu

rse

or a

gen

eral

nur

se

Med

icat

ion

nurs

es

rece

ived

a 1

-day

8-

h m

edic

atio

n sa

fety

pro

gram

N

urse

s as

sign

ed b

etw

een

15 a

nd 1

8 p

atie

nts

each

A

dmin

iste

red

all s

ched

uled

m

edic

atio

ns t

o th

eir

assi

gned

pat

ient

s un

less

una

ble

to a

dmin

iste

r tim

e cr

itica

l med

icat

ions

suc

h as

insu

lin i

n w

hich

cas

e as

ked

for

assi

stan

ce f

rom

st

aff

nurs

es o

n th

e un

it D

id n

ot

adm

inis

ter

Stat

med

icin

es

tota

l p

aren

tal n

utrit

ion

hyd

ratio

n or

bol

us

med

icat

ions

Th

ese

hand

led

by

unm

onito

red

staf

f nu

rses

G

ener

al n

urse

s p

rovi

ded

nurs

ing

care

in

the

usu

al m

anne

r co

verin

g 6

pat

ient

s ea

ch

Obs

erve

d on

ly w

hen

pro

vidi

ng m

edic

atio

nSt

udy

cond

ucte

d si

mul

tane

ousl

y at

th

e 2

hosp

itals

in t

wo

6-w

eek

bloc

ks

5 da

ys p

er w

eek

excl

udin

g th

e w

eeke

nds

Med

icat

ion

erro

r ra

tes

(err

ors

opp

ortu

nitie

s)

Cal

cula

ted

for

wro

ng

bull M

edic

atio

nbull

Dos

ebull

Dos

e fo

rmbull

Rout

ebull

Rate

bull D

ose

pre

par

atio

nbull

Adm

inis

trat

ion

tech

niq

ueA

nd d

rug

omis

sion

12 w

eeks

Bayn

e an

d Bi

ndle

r19

9712

IIQ

S 7

11C

linic

al

imp

orta

nce

34

R no

t es

timab

le

Thre

e he

alth

care

fa

cilit

ies

in

the

USA

bull

Teac

hing

ho

spita

lbull

Tert

iary

car

eho

spita

lbull

Hom

e he

alth

care

ag

ency

Rand

omis

ed

cont

rolle

d tr

ial

69 R

Ns

Nur

ses

rand

omly

ass

igne

d to

1 o

f 4

inte

rven

tion

grou

ps

Con

trol

(n

= 1

8)

nurs

es w

ere

inst

ruct

ed n

ot t

o up

date

the

ir ca

lcul

atio

n sk

ills

in a

ny m

anne

r ot

her

than

nor

mal

ly n

eces

sary

for t

heir

wor

k si

tuat

ion

Com

pute

r-as

sist

ed in

stru

ctio

n(n

= 1

4)

nurs

es in

stru

cted

to

use

a p

rogr

am (

NU

RS P

ROC

ALC

Pr

ofes

sion

al D

evel

opm

ent

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war

e

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pel

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N

C

USA

) fo

r at

leas

t 3

hSe

lf-st

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wor

kboo

k (

n =

18)

nur

ses

inst

ruct

ed t

o w

ork

on t

he w

orkb

ook

for

a m

inim

um o

f 3

hC

lass

room

inst

ruct

ion

(n

= 17

) n

urse

s p

rovi

ded

with

a 3

-h c

lass

con

cern

ing

med

icat

ion

calc

ulat

ion

taug

ht b

y a

nurs

e ed

ucat

or

No

othe

r de

scrip

tions

of

the

inte

rven

tion

wer

e gi

ven

Pre-

and

pos

t-in

stru

ctio

n te

st s

core

sM

ean

plusmn

SD

Post

-tes

t gi

ven

4ndash5

mon

ths

afte

r p

re-t

est

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

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rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

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1 n

urse

ad

min

iste

ring

med

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ions

Con

trol

for

seco

nd 2

3 w

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2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

edic

atio

nM

edic

atio

n ch

art

not

sign

ed

23 w

eeks

fo

r ea

ch

segm

ent

46 w

eeks

in t

otal

Stud

yLe

vel o

f ev

iden

ceA

pp

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al

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udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

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rele

vanc

e R

N

regi

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ed n

urse



Con

trol

led

tria

ls

Stud

yLe

vel o

f ev

iden

ceA

pp

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al

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catio

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Inte

rven

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Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Kucu

kars

lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

al p

harm

acis

ts a

ndin

pat

ient

s ad

mitt

ed t

o 1

of2

inte

rnal

med

icin

e un

its

Con

trol

gro

up

n =

79M

ean

age

56

5 plusmn

196

yea

rs36

mal

e 4

3 fe

mal

eSt

udy

grou

pn

= 86

Mea

n ag

e 5

39

plusmn 19

8 y

ears

36 m

ale

50

fem

ale

Con

trol

p

atie

nts

in t

his

grou

p r

ecei

ved

stan

dard

ca

re f

rom

pha

rmac

ists

with

a

ratio

of

1 p

harm

acis

t fo

r ev

ery

30 p

atie

nts

Prev

enta

ble

drug

eve

nts

Even

ts1

000

pat

ient

day

sEv

ents

tot

al p

atie

nts

87 d

ays

fro

m5

Sep

tem

ber

to30

Nov

embe

r

Stud

y 2

clin

ical

pha

rmac

ists

as

sign

ed t

o p

atie

nt c

are

at

beds

ide

incl

udin

g ro

unds

do

cum

enta

tion

of

pha

rmac

othe

rap

y hi

stor

y an

d p

rovi

ding

dis

char

ge

coun

selli

ng

Pap

e

2003

25III

-2Q

S 7

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Med

ical

su

rgic

al u

nit

of a

cute

car

eho

spita

l TX

U

SA

Con

trol

led

tria

lC

onve

nien

ce s

amp

le o

f re

gist

ered

nur

ses

on a

m

edic

al s

urgi

cal u

nit

of 3

0 p

atie

nts

Con

trol

to

tal o

f 8

cycl

es

Nur

ses

used

cus

tom

ary

med

icat

ion

adm

inis

trat

ion

pro

cedu

res

Focu

sed

prot

ocol

to

tal o

f 8

cycl

es

A lsquo

spec

ial n

urse

rsquo de

sign

ated

and

sta

ff as

ked

to n

ot in

terr

upt

or d

istr

act

the

spec

ial n

urse

unl

ess

rela

ted

to m

edic

atio

ns

bein

g ad

min

iste

red

Med

safe

pro

toco

l to

tal o

f 8

cycl

es

Nur

se a

dmin

iste

ring

med

icat

ions

ask

ed to

wea

r a

spec

ial v

est

that

iden

tified

th

em a

s in

the

pro

cess

of

adm

inis

terin

g m

edic

atio

ns

Vest

labe

lled

with

a

lsquoMed

safe

Nur

se

do n

ot

dist

urbrsquo

O

ther

nur

ses

inst

ruct

ed t

o no

t in

terr

upt

Med

safe

nur

se a

nd t

o in

terc

ept

all p

hone

cal

ls o

r ot

her

dist

ract

ions

Num

ber

of d

istr

actio

nsm

easu

red

by n

umbe

r p

ercy

cle

and

tota

l dis

trac

tions

over

mea

sure

men

t p

erio

dA

cyc

le w

as d

efine

d as

begi

nnin

g w

hen

the

nurs

ein

itiat

ed a

dmin

istr

atio

nof

all

assi

gned

pat

ient

med

icat

ions

and

end

whe

ndo

cum

enta

tion

of

adm

inis

tere

d m

edic

atio

nsis

com

ple

ted

24 t

otal

cyc

les

8 cy

cles

per

in

terv

entio

n

QS

qua

lity

scor

e R

re

leva

nce



Oth

er e

xper

imen

tal d

esig

ns

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

al im

por

tanc

eno

t es

timab

leR

not

estim

able

Thre

e st

ates

in t

he U

SA

Neb

rask

aG

eorg

ia

Penn

sylv

ania

Litt

lein

form

atio

nLi

kely

a b

efor

ean

d af

ter

tria

l

Nur

sing

sta

ff in

nurs

ing

units

Pre

sta

ndar

d ca

re

Post

be

dsid

e co

mp

uter

te

rmin

als

pro

vide

d co

ntai

ning

fu

ll cl

inic

al in

form

atio

n of

p

atie

nts

in u

nit

Med

icat

ion

erro

rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

lA

ll RN

s in

the

m

edic

al c

ente

rPr

e a

ll RN

s re

qui

red

to p

ass

a ye

arly

med

icat

ion

exam

inat

ion

N

umbe

r of

med

icat

ion

erro

rs

rep

orte

d on

inci

dent

for

ms

reco

rded

for

an

8-m

onth

p

erio

dPo

st

no m

edic

atio

n ex

amin

atio

n er

rors

rep

orte

d on

in

cide

nt f

orm

s re

cord

ed f

or a

n 8-

mon

th p

erio

d in

the

fo

llow

ing

year

aft

er

req

uire

men

t fo

r m

edic

atio

n ex

amin

atio

ns a

bolis

hed

Med

icat

ion

erro

r t

otal

erro

rs8

-mon

th p

erio

dA

med

icat

ion

erro

r w

as

defin

ed a

s w

rong

m

edic

atio

n or

ext

ra d

ose

wro

ng p

atie

nt

rout

e or

rat

e o

f in

trav

enou

s flu

id

omitt

ing

a m

edic

atio

np

rovi

ding

a m

edic

atio

nfr

om a

n ex

pire

d or

der

or

adm

inis

terin

g a

med

icat

ion

ge30

min

bef

ore

or a

fter

th

e sc

hedu

led

time

8 m

onth

s be

fore

and

8

mon

ths a

fter

ch

ange

in

pol

icy

Shah

et

al

19

9446

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

SA

Befo

re a

ndaf

ter

tria

lA

ll cl

inic

al s

taff

Pre

no

rovi

ng p

harm

acis

tPo

st

rovi

ng p

harm

acis

t em

plo

yed

betw

een

8 A

M a

nd

4 PM

C

arry

ing

out

roun

ds

ever

y 0

5 h

on a

ll de

sign

ated

un

its P

erfo

rmin

g m

edic

atio

n or

der

entr

y an

d p

rovi

ding

a

reso

urce

to

nurs

ing

staf

f an

d p

hysi

cian

s D

ealt

with

any

or

derin

g p

robl

ems

Med

icat

ion

inci

dent

s re

por

ted

Erro

rsp

atie

nt d

ays

Dat

a co

llect

ed fo

r 4

year

s be

fore

3

year

s af

ter

inte

rven

tion

Haw

key

et a

l19

9017

IVQ

S no

t es

timab

leC

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Six

hosp

itals

in t

heN

ottin

gham

area

U

K

Obs

erva

tiona

ltr

ial

All

hosp

ital

inp

atie

nts

and

outp

atie

nts

Reco

rdin

g of

eve

ry im

por

tant

in

terv

entio

n m

ade

by

pha

rmac

ists

to

all p

resc

riptio

ns

and

adm

inis

trat

ion

of

med

icin

es f

or a

per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

able

cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Hei

nem

ann

et a

l

1996

19

III-1

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Nur

sing

uni

tsof

a p

rivat

eno

n-fo

r-p

rofit

com

mun

ity

med

ical

cent

re

FL

USA

Pseu

do-

rand

omis

ed

(by

war

d)

Con

trol

gro

up

34-

bed

surg

ical

tra

uma

unit

Pilo

t tr

eatm

ent

grou

p 3

6-be

d or

thop

aedi

c tr

aum

aun

it

Con

trol

gro

up

use

the

tota

l pat

ient

ca

re m

odel

Pi

lot

trea

tmen

t gr

oup

use

the

PIP

C

mod

el

This

pro

toco

l inc

lude

d th

e co

ncur

rent

intr

oduc

tion

of

bull Pa

rtic

ipat

ive

deci

sion

-mak

ing

by

staf

f th

roug

hout

the

dev

elop

men

t

desi

gn

imp

lem

enta

tion

and

test

ing

Med

icat

ion

erro

rs

Defi

ned

as t

hose

inci

dent

sth

at d

evia

ted

from

st

anda

rd p

roce

dure

and

w

ere

clea

rly t

he

resp

onsi

bilit

y of

nur

sing

Er

rors

der

ived

fro

m

offic

ial i

ncid

ent

rep

orts

6-m

onth

obse

rvat

ion

per

iod

bull U

se o

f a

par

tner

in p

atie

nt c

are

exte

nder

und

er th

e di

rect

ion

of a

n RN

bull

Cla

sses

to

educ

ate

staf

f to

the

dy

nam

ics

of c

hang

e in

the

pra

ctic

e en

viro

nmen

tbull

Cla

sses

in d

eleg

atio

n to

hel

p th

e RN

s to

del

egat

e ap

pro

pria

te t

asks

to

thei

r PI

PC e

xten

der

Des

crib

ed b

y nu

mbe

r of

inci

dent

s p

er p

atie

nt d

ay

Krus

e et

al

19

9221

III-1

QS

811

Clin

ical

imp

orta

nce

24

R 2

5

Thre

e w

ard

of a

ger

iatr

icas

sess

men

t an

d re

habi

litat

ion

unit

NSW

A

ustr

alia

Pseu

do-

rand

omis

ed

(by

war

d)

Cro

ss-o

ver

RNs

War

d A

Con

trol

for

firs

t 23

wee

ks

2 nu

rses

adm

inis

terin

g m

edic

atio

ns

Tria

l for

sec

ond

23 w

eeks

1

nurs

e ad

min

iste

ring

med

icat

ions

W

ard

B T

rial f

or fi

rst 2

3 w

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1 n

urse

ad

min

iste

ring

med

icat

ions

Con

trol

for

seco

nd 2

3 w

eeks

2

nurs

es

adm

inis

terin

g m

edic

atio

ns

War

d C

C

ontr

ol f

or fi

rst

and

seco

nd 2

3w

eeks

2

nurs

es a

dmin

iste

ring

med

icat

ions

A

udit

of c

hart

s by

an

inde

pen

dent

ob

serv

er

Med

icat

ion

erro

rs

mea

sure

d by

err

ors

per

num

ber

of

med

icat

ions

dis

pen

sed

Erro

rs d

efine

d by

W

rong

Pa

tient

Med

icat

ion

Dos

age

Tim

eO

mitt

ed m

edic

atio

nM

edic

atio

n ch

art

not

sign

ed

23 w

eeks

fo

r ea

ch

segm

ent

46 w

eeks

in t

otal

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

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ulat

ion

Inte

rven

tion

Out

com

es a

sses

sed

Leng

th o

ffo

llow

-up

PIPC

p

artn

er in

pat

ient

car

e Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

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urse



Con

trol

led

tria

ls

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

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gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Kucu

kars

lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

al p

harm

acis

ts a

ndin

pat

ient

s ad

mitt

ed t

o 1

of2

inte

rnal

med

icin

e un

its

Con

trol

gro

up

n =

79M

ean

age

56

5 plusmn

196

yea

rs36

mal

e 4

3 fe

mal

eSt

udy

grou

pn

= 86

Mea

n ag

e 5

39

plusmn 19

8 y

ears

36 m

ale

50

fem

ale

Con

trol

p

atie

nts

in t

his

grou

p r

ecei

ved

stan

dard

ca

re f

rom

pha

rmac

ists

with

a

ratio

of

1 p

harm

acis

t fo

r ev

ery

30 p

atie

nts

Prev

enta

ble

drug

eve

nts

Even

ts1

000

pat

ient

day

sEv

ents

tot

al p

atie

nts

87 d

ays

fro

m5

Sep

tem

ber

to30

Nov

embe

r

Stud

y 2

clin

ical

pha

rmac

ists

as

sign

ed t

o p

atie

nt c

are

at

beds

ide

incl

udin

g ro

unds

do

cum

enta

tion

of

pha

rmac

othe

rap

y hi

stor

y an

d p

rovi

ding

dis

char

ge

coun

selli

ng

Pap

e

2003

25III

-2Q

S 7

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Med

ical

su

rgic

al u

nit

of a

cute

car

eho

spita

l TX

U

SA

Con

trol

led

tria

lC

onve

nien

ce s

amp

le o

f re

gist

ered

nur

ses

on a

m

edic

al s

urgi

cal u

nit

of 3

0 p

atie

nts

Con

trol

to

tal o

f 8

cycl

es

Nur

ses

used

cus

tom

ary

med

icat

ion

adm

inis

trat

ion

pro

cedu

res

Focu

sed

prot

ocol

to

tal o

f 8

cycl

es

A lsquo

spec

ial n

urse

rsquo de

sign

ated

and

sta

ff as

ked

to n

ot in

terr

upt

or d

istr

act

the

spec

ial n

urse

unl

ess

rela

ted

to m

edic

atio

ns

bein

g ad

min

iste

red

Med

safe

pro

toco

l to

tal o

f 8

cycl

es

Nur

se a

dmin

iste

ring

med

icat

ions

ask

ed to

wea

r a

spec

ial v

est

that

iden

tified

th

em a

s in

the

pro

cess

of

adm

inis

terin

g m

edic

atio

ns

Vest

labe

lled

with

a

lsquoMed

safe

Nur

se

do n

ot

dist

urbrsquo

O

ther

nur

ses

inst

ruct

ed t

o no

t in

terr

upt

Med

safe

nur

se a

nd t

o in

terc

ept

all p

hone

cal

ls o

r ot

her

dist

ract

ions

Num

ber

of d

istr

actio

nsm

easu

red

by n

umbe

r p

ercy

cle

and

tota

l dis

trac

tions

over

mea

sure

men

t p

erio

dA

cyc

le w

as d

efine

d as

begi

nnin

g w

hen

the

nurs

ein

itiat

ed a

dmin

istr

atio

nof

all

assi

gned

pat

ient

med

icat

ions

and

end

whe

ndo

cum

enta

tion

of

adm

inis

tere

d m

edic

atio

nsis

com

ple

ted

24 t

otal

cyc

les

8 cy

cles

per

in

terv

entio

n

QS

qua

lity

scor

e R

re

leva

nce



Oth

er e

xper

imen

tal d

esig

ns

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

al im

por

tanc

eno

t es

timab

leR

not

estim

able

Thre

e st

ates

in t

he U

SA

Neb

rask

aG

eorg

ia

Penn

sylv

ania

Litt

lein

form

atio

nLi

kely

a b

efor

ean

d af

ter

tria

l

Nur

sing

sta

ff in

nurs

ing

units

Pre

sta

ndar

d ca

re

Post

be

dsid

e co

mp

uter

te

rmin

als

pro

vide

d co

ntai

ning

fu

ll cl

inic

al in

form

atio

n of

p

atie

nts

in u

nit

Med

icat

ion

erro

rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

lA

ll RN

s in

the

m

edic

al c

ente

rPr

e a

ll RN

s re

qui

red

to p

ass

a ye

arly

med

icat

ion

exam

inat

ion

N

umbe

r of

med

icat

ion

erro

rs

rep

orte

d on

inci

dent

for

ms

reco

rded

for

an

8-m

onth

p

erio

dPo

st

no m

edic

atio

n ex

amin

atio

n er

rors

rep

orte

d on

in

cide

nt f

orm

s re

cord

ed f

or a

n 8-

mon

th p

erio

d in

the

fo

llow

ing

year

aft

er

req

uire

men

t fo

r m

edic

atio

n ex

amin

atio

ns a

bolis

hed

Med

icat

ion

erro

r t

otal

erro

rs8

-mon

th p

erio

dA

med

icat

ion

erro

r w

as

defin

ed a

s w

rong

m

edic

atio

n or

ext

ra d

ose

wro

ng p

atie

nt

rout

e or

rat

e o

f in

trav

enou

s flu

id

omitt

ing

a m

edic

atio

np

rovi

ding

a m

edic

atio

nfr

om a

n ex

pire

d or

der

or

adm

inis

terin

g a

med

icat

ion

ge30

min

bef

ore

or a

fter

th

e sc

hedu

led

time

8 m

onth

s be

fore

and

8

mon

ths a

fter

ch

ange

in

pol

icy

Shah

et

al

19

9446

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

SA

Befo

re a

ndaf

ter

tria

lA

ll cl

inic

al s

taff

Pre

no

rovi

ng p

harm

acis

tPo

st

rovi

ng p

harm

acis

t em

plo

yed

betw

een

8 A

M a

nd

4 PM

C

arry

ing

out

roun

ds

ever

y 0

5 h

on a

ll de

sign

ated

un

its P

erfo

rmin

g m

edic

atio

n or

der

entr

y an

d p

rovi

ding

a

reso

urce

to

nurs

ing

staf

f an

d p

hysi

cian

s D

ealt

with

any

or

derin

g p

robl

ems

Med

icat

ion

inci

dent

s re

por

ted

Erro

rsp

atie

nt d

ays

Dat

a co

llect

ed fo

r 4

year

s be

fore

3

year

s af

ter

inte

rven

tion

Haw

key

et a

l19

9017

IVQ

S no

t es

timab

leC

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Six

hosp

itals

in t

heN

ottin

gham

area

U

K

Obs

erva

tiona

ltr

ial

All

hosp

ital

inp

atie

nts

and

outp

atie

nts

Reco

rdin

g of

eve

ry im

por

tant

in

terv

entio

n m

ade

by

pha

rmac

ists

to

all p

resc

riptio

ns

and

adm

inis

trat

ion

of

med

icin

es f

or a

per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

able

cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

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itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Con

trol

led

tria

ls

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Kucu

kars

lan

et a

l

2003

22

III-2

QS

811

Clin

ical

im

por

tanc

e 1

4R

25

Gen

eral

ho

spita

l M

I U

SA

Con

trol

led

tria

lSi

x cl

inic

al p

harm

acis

ts a

ndin

pat

ient

s ad

mitt

ed t

o 1

of2

inte

rnal

med

icin

e un

its

Con

trol

gro

up

n =

79M

ean

age

56

5 plusmn

196

yea

rs36

mal

e 4

3 fe

mal

eSt

udy

grou

pn

= 86

Mea

n ag

e 5

39

plusmn 19

8 y

ears

36 m

ale

50

fem

ale

Con

trol

p

atie

nts

in t

his

grou

p r

ecei

ved

stan

dard

ca

re f

rom

pha

rmac

ists

with

a

ratio

of

1 p

harm

acis

t fo

r ev

ery

30 p

atie

nts

Prev

enta

ble

drug

eve

nts

Even

ts1

000

pat

ient

day

sEv

ents

tot

al p

atie

nts

87 d

ays

fro

m5

Sep

tem

ber

to30

Nov

embe

r

Stud

y 2

clin

ical

pha

rmac

ists

as

sign

ed t

o p

atie

nt c

are

at

beds

ide

incl

udin

g ro

unds

do

cum

enta

tion

of

pha

rmac

othe

rap

y hi

stor

y an

d p

rovi

ding

dis

char

ge

coun

selli

ng

Pap

e

2003

25III

-2Q

S 7

11C

linic

al

imp

orta

nce

not

estim

able

R 2

5

Med

ical

su

rgic

al u

nit

of a

cute

car

eho

spita

l TX

U

SA

Con

trol

led

tria

lC

onve

nien

ce s

amp

le o

f re

gist

ered

nur

ses

on a

m

edic

al s

urgi

cal u

nit

of 3

0 p

atie

nts

Con

trol

to

tal o

f 8

cycl

es

Nur

ses

used

cus

tom

ary

med

icat

ion

adm

inis

trat

ion

pro

cedu

res

Focu

sed

prot

ocol

to

tal o

f 8

cycl

es

A lsquo

spec

ial n

urse

rsquo de

sign

ated

and

sta

ff as

ked

to n

ot in

terr

upt

or d

istr

act

the

spec

ial n

urse

unl

ess

rela

ted

to m

edic

atio

ns

bein

g ad

min

iste

red

Med

safe

pro

toco

l to

tal o

f 8

cycl

es

Nur

se a

dmin

iste

ring

med

icat

ions

ask

ed to

wea

r a

spec

ial v

est

that

iden

tified

th

em a

s in

the

pro

cess

of

adm

inis

terin

g m

edic

atio

ns

Vest

labe

lled

with

a

lsquoMed

safe

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se

do n

ot

dist

urbrsquo

O

ther

nur

ses

inst

ruct

ed t

o no

t in

terr

upt

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safe

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se a

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o in

terc

ept

all p

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r ot

her

dist

ract

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Num

ber

of d

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g w

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the

nurs

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itiat

ed a

dmin

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atio

nof

all

assi

gned

pat

ient

med

icat

ions

and

end

whe

ndo

cum

enta

tion

of

adm

inis

tere

d m

edic

atio

nsis

com

ple

ted

24 t

otal

cyc

les

8 cy

cles

per

in

terv

entio

n

QS

qua

lity

scor

e R

re

leva

nce



Oth

er e

xper

imen

tal d

esig

ns

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

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desi

gnSt

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pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

al im

por

tanc

eno

t es

timab

leR

not

estim

able

Thre

e st

ates

in t

he U

SA

Neb

rask

aG

eorg

ia

Penn

sylv

ania

Litt

lein

form

atio

nLi

kely

a b

efor

ean

d af

ter

tria

l

Nur

sing

sta

ff in

nurs

ing

units

Pre

sta

ndar

d ca

re

Post

be

dsid

e co

mp

uter

te

rmin

als

pro

vide

d co

ntai

ning

fu

ll cl

inic

al in

form

atio

n of

p

atie

nts

in u

nit

Med

icat

ion

erro

rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

lA

ll RN

s in

the

m

edic

al c

ente

rPr

e a

ll RN

s re

qui

red

to p

ass

a ye

arly

med

icat

ion

exam

inat

ion

N

umbe

r of

med

icat

ion

erro

rs

rep

orte

d on

inci

dent

for

ms

reco

rded

for

an

8-m

onth

p

erio

dPo

st

no m

edic

atio

n ex

amin

atio

n er

rors

rep

orte

d on

in

cide

nt f

orm

s re

cord

ed f

or a

n 8-

mon

th p

erio

d in

the

fo

llow

ing

year

aft

er

req

uire

men

t fo

r m

edic

atio

n ex

amin

atio

ns a

bolis

hed

Med

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r t

otal

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med

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erro

r w

as

defin

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rong

m

edic

atio

n or

ext

ra d

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ng p

atie

nt

rout

e or

rat

e o

f in

trav

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s flu

id

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edic

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rovi

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om a

n ex

pire

d or

der

or

adm

inis

terin

g a

med

icat

ion

ge30

min

bef

ore

or a

fter

th

e sc

hedu

led

time

8 m

onth

s be

fore

and

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mon

ths a

fter

ch

ange

in

pol

icy

Shah

et

al

19

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611

Clin

ical

imp

orta

nce

not

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able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

SA

Befo

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al s

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Dat

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Reco

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eve

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por

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in

terv

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n m

ade

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pha

rmac

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to

all p

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inis

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med

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per

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of

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Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

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cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

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omp

uter

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ualit

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rele

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N

regi

ster

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urse



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ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

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re a

ndaf

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tria

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mitt

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hen

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pot

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rror

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th

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nit

per

mon

th w

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ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

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ys o

f med

icat

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docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

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day

1-ye

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per

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of

follo

w-u

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afte

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0318

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im

por

tanc

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4R

25

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units

of

a s

tudy

hosp

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MI

USA

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thor

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and

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it

Con

trol

st

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stitu

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of t

he

inte

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Trea

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tim

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sulin

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writ

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tim

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whe

n th

e p

roce

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p

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Inte

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bet

wee

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min

)

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here

insu

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min

afte

r bl

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test

(in

)

1-m

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pre

inte

rven

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data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

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over

per

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and

furt

her

1-m

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data

colle

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np

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d

Stud

yLe

vel o

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pop

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Inte

rven

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Out

com

es(s

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sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

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ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

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rder

ing

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y Q

S q

ualit

y sc

ore

R

rele

vanc

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N

regi

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Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

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ener

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edic

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pat

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edic

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art

fillin

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chni

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s

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trol

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art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

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n of

the

fol

low

ing

day

med

icat

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adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

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for

each

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edst

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ased

on

the

spec

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need

s of

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uni

t T

he

med

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pro

file

for

each

p

atie

nt is

est

ablis

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by t

he

pha

rmac

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d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

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roce

ssed

no

lag

time)

an

d tr

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ap

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nur

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resc

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m

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n re

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med

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imp

orta

nce

not

estim

able

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t es

timab

le

Four

uni

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a95

0-be

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l N

C

USA

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re a

ndaf

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cens

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sPr

e n

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sign

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n to

al

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units

fr

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rovi

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n to

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Num

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of m

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in e

ach

unit

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Stud

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pop

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Inte

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com

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sess

edLe

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E c

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phy

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rele

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N

regi

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an

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l

2002

20

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QS

711

Clin

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imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

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pat

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units

of

hosp

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Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

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d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

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ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

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ns b

efor

e ad

min

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atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

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n in

cide

nt r

ecor

ds

Pre

7 m

onth

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st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

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Com

mun

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spita

l A

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USA

Pros

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ser

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Con

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sam

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pat

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s se

en

over

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s

A co

mpu

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aler

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stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

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ug e

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ry

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Defi

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9514

III-3

QS

711

Clin

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imp

orta

nce

not

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able

R no

t es

timab

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Com

mun

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spita

l N

H

USA

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Con

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Th

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The

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Med

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rms

Erro

rs d

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var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

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n

Ada

ms

19

8911

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QS

511

Clin

ical

imp

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nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

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SC

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re a

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invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Oth

er e

xper

imen

tal d

esig

ns

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

Cer

ne

1989

15III

-3Q

S no

t es

timab

leC

linic

al im

por

tanc

eno

t es

timab

leR

not

estim

able

Thre

e st

ates

in t

he U

SA

Neb

rask

aG

eorg

ia

Penn

sylv

ania

Litt

lein

form

atio

nLi

kely

a b

efor

ean

d af

ter

tria

l

Nur

sing

sta

ff in

nurs

ing

units

Pre

sta

ndar

d ca

re

Post

be

dsid

e co

mp

uter

te

rmin

als

pro

vide

d co

ntai

ning

fu

ll cl

inic

al in

form

atio

n of

p

atie

nts

in u

nit

Med

icat

ion

erro

rs a

s

of

pre

viou

s tim

e p

erio

dN

ot s

tate

d

Ludw

ig

Beym

er

et a

l

1990

24

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

itym

edic

alce

ntre

U

SA

Befo

re a

ndaf

ter

tria

lA

ll RN

s in

the

m

edic

al c

ente

rPr

e a

ll RN

s re

qui

red

to p

ass

a ye

arly

med

icat

ion

exam

inat

ion

N

umbe

r of

med

icat

ion

erro

rs

rep

orte

d on

inci

dent

for

ms

reco

rded

for

an

8-m

onth

p

erio

dPo

st

no m

edic

atio

n ex

amin

atio

n er

rors

rep

orte

d on

in

cide

nt f

orm

s re

cord

ed f

or a

n 8-

mon

th p

erio

d in

the

fo

llow

ing

year

aft

er

req

uire

men

t fo

r m

edic

atio

n ex

amin

atio

ns a

bolis

hed

Med

icat

ion

erro

r t

otal

erro

rs8

-mon

th p

erio

dA

med

icat

ion

erro

r w

as

defin

ed a

s w

rong

m

edic

atio

n or

ext

ra d

ose

wro

ng p

atie

nt

rout

e or

rat

e o

f in

trav

enou

s flu

id

omitt

ing

a m

edic

atio

np

rovi

ding

a m

edic

atio

nfr

om a

n ex

pire

d or

der

or

adm

inis

terin

g a

med

icat

ion

ge30

min

bef

ore

or a

fter

th

e sc

hedu

led

time

8 m

onth

s be

fore

and

8

mon

ths a

fter

ch

ange

in

pol

icy

Shah

et

al

19

9446

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l N

J U

SA

Befo

re a

ndaf

ter

tria

lA

ll cl

inic

al s

taff

Pre

no

rovi

ng p

harm

acis

tPo

st

rovi

ng p

harm

acis

t em

plo

yed

betw

een

8 A

M a

nd

4 PM

C

arry

ing

out

roun

ds

ever

y 0

5 h

on a

ll de

sign

ated

un

its P

erfo

rmin

g m

edic

atio

n or

der

entr

y an

d p

rovi

ding

a

reso

urce

to

nurs

ing

staf

f an

d p

hysi

cian

s D

ealt

with

any

or

derin

g p

robl

ems

Med

icat

ion

inci

dent

s re

por

ted

Erro

rsp

atie

nt d

ays

Dat

a co

llect

ed fo

r 4

year

s be

fore

3

year

s af

ter

inte

rven

tion

Haw

key

et a

l19

9017

IVQ

S no

t es

timab

leC

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Six

hosp

itals

in t

heN

ottin

gham

area

U

K

Obs

erva

tiona

ltr

ial

All

hosp

ital

inp

atie

nts

and

outp

atie

nts

Reco

rdin

g of

eve

ry im

por

tant

in

terv

entio

n m

ade

by

pha

rmac

ists

to

all p

resc

riptio

ns

and

adm

inis

trat

ion

of

med

icin

es f

or a

per

iod

of

28 d

ays

Num

ber

of in

terv

entio

ns

Num

ber

of w

arra

nted

in

terv

entio

ns

Num

ber

of c

ases

whe

re

pre

scrip

tion

was

alte

red

Num

ber

of c

ases

whe

re

app

reci

able

cha

nges

wer

e m

ade

28 d

ays

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Scha

ubhu

tan

d Jo

nes

2000

29

III-3

QS

611

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Gen

eral

ho

spita

l LA

U

SA

Befo

re a

ndaf

ter

tria

lA

ll in

pat

ient

sIn

terd

isci

plin

ary

com

mitt

ee

form

ed

Con

sist

s of

St

aff

nurs

esN

urse

man

ager

sPh

arm

acis

tsIn

form

atio

n sy

stem

sA

naly

sts

Risk

man

ager

Nur

sing

edu

cato

rC

omm

ittee

to

revi

ew a

ll re

por

ted

erro

rs a

nd t

hen

the

pot

entia

l cau

ses

of e

rror

id

entifi

ed T

his i

nfor

mat

ion

was

th

en s

hare

d w

ith s

taff

with

re

gula

r lsquoH

ot S

pot

srsquo b

riefs

A

ll nu

rsin

g un

its r

evie

wed

by

sele

ctin

g 10

pat

ient

s p

er u

nit

per

mon

th w

ith e

ach

sele

cted

p

atie

nts

char

t re

view

ed f

or 7

co

nsec

utiv

e da

ys o

f med

icat

ion

docu

men

tatio

n

No

of

docu

men

tatio

n er

rors

per

pat

ient

day

1-ye

ar

per

iod

of

follo

w-u

p

afte

r in

terv

entio

n

Hea

tlie

20

0318

III-3

QS

611

Clin

ical

im

por

tanc

e 1

4R

25

Nur

sing

units

of

a s

tudy

hosp

ital

MI

USA

Befo

re a

ndaf

ter

tria

lD

iabe

tic p

atie

nts

on 3

nur

sing

un

its

a ca

rdia

c

thor

acic

and

ne

uros

urgi

cal

unit

a c

ardi

o-p

rogr

essi

ve u

nit

and

anor

thop

aedi

c un

it

Con

trol

st

anda

rd p

ract

ice

befo

re t

he in

stitu

tion

of t

he

inte

rven

tion

Trea

tmen

t n

ursi

ng e

duca

tion

pro

gram

hig

hlig

htin

g th

e im

por

tanc

e of

the

tim

ing

of

bloo

d gl

ucos

e de

term

inat

ions

an

d th

e su

bseq

uent

ad

min

istr

atio

n of

insu

lin

Prov

isio

n of

cap

illar

y bl

ood

gluc

ose

mon

itors

for a

ll un

its to

al

low

bed

side

tes

ting

Tim

e an

d do

se n

otat

ions

re

mov

ed f

rom

MA

R fo

rcin

g nu

rse

adm

inis

terin

g th

e in

sulin

to

writ

e in

the

tim

e an

d do

se

whe

n th

e p

roce

dure

was

p

erfo

rmed

Inte

rval

bet

wee

n bl

ood

gluc

ose

test

and

insu

linad

min

istr

atio

n (in

min

)

Prop

ortio

n of

cas

es w

here

insu

lin p

rovi

ded

ge60

min

afte

r bl

ood

gluc

ose

test

(in

)

1-m

onth

pre

inte

rven

tion

data

co

llect

ion

per

iod

follo

wed

by

a 6-

mon

thch

ange

over

per

iod

and

furt

her

1-m

onth

data

colle

ctio

np

erio

d

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Ray

et a

l

1995

28

III-3

QS

711

Clin

ical

im

por

tanc

e 2

4R

35

Uni

vers

ity

hosp

ital

San

Die

go

CA

U

SA

Befo

re a

ndaf

ter

tria

lG

ener

al m

edic

al

pat

ient

s an

d m

edic

al c

art

fillin

gte

chni

cian

s

Con

trol

un

it-do

se c

art

fill

syst

em I

nvol

ves

24 m

edic

atio

n ca

sset

te c

hang

e In

ant

icip

atio

n of

the

fol

low

ing

day

med

icat

ion

adm

inis

trat

ion

for

each

pat

ient

U

nit

dose

s ar

e p

rodu

ced

in t

he p

harm

acy

and

deliv

ered

to

the

unit

ever

y 24

h

Med

stat

ion

Rx

an in

vent

ory

is

esta

blis

hed

for

each

M

edst

atio

n ca

rt b

ased

on

the

spec

ific

need

s of

the

uni

t T

he

med

icat

ion

pro

file

for

each

p

atie

nt is

est

ablis

hed

by t

he

pha

rmac

y an

d do

wnl

oade

d to

th

e ce

ntra

l ter

min

al (

in r

eal

time

ie

it h

app

ens

as q

uick

ly

as it

is p

roce

ssed

no

lag

time)

an

d tr

ansf

erre

d to

the

ap

pro

pria

te c

onso

le o

n th

e w

ard

The

nur

se c

an th

en s

elec

t th

e p

atie

ntrsquos

nam

e an

d th

e p

resc

ribed

med

icat

ion

The

m

edic

atio

n is

the

n re

leas

ed

from

the

med

icat

ion

draw

er o

n th

e ca

rt

Tech

nici

an e

rror

rat

e in

fillin

gPr

e6

wee

ks

Post

6

wee

ks

Brow

n et

al

19

9313

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Four

uni

tsof

a95

0-be

d ho

spita

l N

C

USA

Befo

re a

ndaf

ter

tria

lLi

cens

ed

pra

ctic

al n

urse

sPr

e n

urse

s p

rovi

de m

edic

atio

n to

ass

igne

d p

atie

nts

Post

de

sign

ated

med

icat

ion

nurs

es p

rovi

de m

edic

atio

n to

al

l pat

ient

s on

res

pec

tive

units

fr

om M

onda

y to

Frid

ay

day

and

even

ing

shift

s O

n w

eeke

nd a

nd n

ight

shi

fts

nurs

es p

rovi

de m

edic

atio

n to

as

sign

ed p

atie

nts

Num

ber

of m

edic

atio

ner

rors

in e

ach

unit

3 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Jarm

an

et a

l

2002

20

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Adu

ltin

pat

ient

units

of

hosp

ital

Gee

long

A

ustr

alia

Befo

re a

ndaf

ter

tria

lC

onve

nien

ce

sam

ple

of

all

RNs

who

wer

e ch

ecke

d as

com

pet

ent

for

sing

lech

ecki

ng o

fm

edic

atio

ns

Pre

stan

dard

pra

ctic

e of

dou

ble

chec

king

of m

edic

atio

ns b

efor

e ad

min

istr

atio

nPo

st

sing

le c

heck

ing

per

form

ed

Rep

orte

d m

edic

atio

n er

rors

Der

ived

fro

m m

edic

atio

n in

cide

nt r

ecor

ds

Pre

7 m

onth

sPo

st

7 m

onth

s

Rasc

hke

et a

l

1998

27

IVQ

S 7

11C

linic

al im

por

tanc

e no

t es

timab

leR

not

estim

able

Com

mun

ityho

spita

l A

Z

USA

Pros

pec

tive

case

ser

ies

Con

secu

tive

sam

ple

of

9306

non-

obst

etric

al

pat

ient

s se

en

over

a p

erio

d of

6 m

onth

s

A co

mpu

ter

aler

t sy

stem

was

cr

eate

d th

at t

arge

ted

37 d

rug-

spec

ific

adve

rse

drug

eve

nts

A

n al

ert

was

gen

erat

ed in

cl

inic

al s

ituat

ions

whe

re t

here

w

as in

crea

sed

risk

of a

n ad

vers

e dr

ug e

vent

-rel

ated

inju

ry

True

-pos

itive

ale

rts

Defi

ned

as a

writ

ten

orde

r by

a p

hysi

cian

bei

ng

cons

iste

nt w

ith t

he

reco

mm

enda

tions

of

the

com

put

er-g

ener

ated

ale

rt

6 m

onth

s

Brow

n et

al

19

9514

III-3

QS

711

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Com

mun

ityho

spita

l N

H

USA

Befo

re a

ndaf

ter

tria

lRN

s w

orki

ng in

a

35-b

ed s

urgi

cal

unit

with

a h

igh

conc

entr

atio

n of

ort

hop

aedi

c p

atie

nts

RNs

wor

king

for

an

ave

rage

of

10 y

ears

and

at

this

hos

pita

l for

an

ave

rage

of

9 ye

ars

77

wer

e fu

lltim

e

Con

trol

re

gula

r ca

re 4

0 h

of

obse

rvat

ion

on d

ay a

nd

even

ing

shift

s of

wee

k da

ys a

nd

1 da

y on

the

wee

kend

In

terv

entio

n b

edsi

de t

erm

inal

sy

stem

Th

e be

dsid

e te

rmin

al

syst

em in

clud

es o

rder

ent

ry

nurs

ing

care

pla

nnin

g

labo

rato

ry a

nd X

-ray

res

ult

rep

ortin

g O

ne h

and-

held

p

orta

ble

term

inal

inst

alle

d in

ea

ch p

atie

nt r

oom

and

2 in

the

ce

ntra

l nur

sing

sta

tion

The

se

term

inal

s co

mm

unic

ate

with

a

term

inal

ser

ver l

ocat

ed o

n ea

ch

unit

40

h of

obs

erva

tion

on

day

and

even

ing

shift

s of

wee

k da

ys a

nd 1

day

on

the

wee

kend

Med

icat

ion

erro

r ra

te

mea

sure

d by

med

icat

ion

erro

rs p

er 1

000

dose

s di

spen

sed

Erro

rs id

entifi

ed f

rom

re

por

ts o

n in

cide

nt

rep

ortin

g fo

rms

Erro

rs d

efine

d as

var

iatio

n fr

om s

tand

ard

pra

ctic

e

40 h

bef

ore

and

afte

rin

terv

entio

n

Ada

ms

19

8911

III-3

QS

511

Clin

ical

imp

orta

nce

not

estim

able

R no

t es

timab

le

Regi

onal

m

edic

al

cent

re

SC

USA

Befo

re a

ndaf

ter

tria

lC

linic

al s

taff

thro

ugho

ut

hosp

ital

invo

lved

with

dr

ug d

eliv

ery

(phy

sici

ans

p

harm

acis

ts

nurs

es)

Pre

14-

day

hand

writ

ten

MAR

Re

qui

red

man

ual

MAR

Re

qui

red

man

ual

colo

urs

of in

k A

sep

arat

e M

AR

was

req

uire

d fo

r ch

emot

hera

py

ant

icoa

gula

nts

and

insu

lin R

esp

irato

ry th

erap

y dr

ugs

wer

e no

t lo

cate

d on

an

MA

R N

o p

roce

dure

to

mat

ch

the

Patie

nt P

rofil

e in

the

Ph

arm

acy

with

the

Nur

sing

M

AR

Post

24

-h c

ompu

ter-

gene

rate

d M

AR

This

MA

R w

as g

ener

ated

di

rect

ly in

the

pha

rmac

y

Med

icat

ion

erro

rs

Nur

ses

on t

he 1

1 PM

to

7 A

Msh

ift w

ould

che

ckth

e or

der

agai

nst

the

MA

RD

iscr

epan

cies

wer

eco

nsid

ered

err

ors

1 ye

ar

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Patt

erso

n

et a

l

2002

26

Ethn

o-gr

aphy

QS

101

0Th

ree

Vete

rans

affa

irsho

spita

ls(a

cute

car

eon

colo

gyan

dnu

rsin

gho

me)

U

SA

Ethn

ogra

phy

O

bser

vatio

n of

med

icat

ion

pas

ses

and

hum

anndash

com

put

er

inte

ract

ion

befo

re

and

afte

rin

trod

ucin

gBC

MA

tech

nolo

gy

RNs

p

hysi

cian

s an

d p

harm

acis

ts

Pre

obs

erva

tion

of s

tand

ard

med

icat

ion

pass

es

Post

BC

MA

soft

war

e ac

cess

ed

usin

g a

lap

top

fixe

d to

a

whe

eled

med

icat

ion

char

t T

his

lap

top

link

ed t

o a

cent

ral

elec

tron

ic d

atab

ase

via

a w

irele

ss n

etw

ork

Sca

nnin

g a

pat

ient

bar

cod

e on

a

wris

tban

d p

rom

pts

the

co

mp

uter

to

list

the

med

icat

ions

tha

t ar

e du

e T

he

bar

code

s of

the

se m

edic

atio

ns

are

then

sca

nned

to

verif

y th

at

the

corr

ect

pat

ient

is g

ettin

g th

e co

rrec

t m

edic

atio

n in

the

co

rrec

t do

se a

t th

e co

rrec

t tim

e I

f th

e sc

anne

d in

form

atio

n on

the

med

icat

ion

does

not

mat

ch

the

nurs

e is

al

erte

d by

a p

op-u

p d

ialo

gue

box

Obs

erva

tion

of t

his

inte

ract

ion

was

per

form

ed f

or 1

ndash7 h

on

day

eve

ning

and

nig

ht s

hift

s In

tere

stin

g in

tera

ctio

n se

que

nces

wer

e an

alys

ed a

s m

ini-c

ases

and

the

n gr

oup

ed

by e

mer

ging

the

mes

Obs

erve

r al

so w

atch

ed

com

put

eris

ed o

rder

ent

ry b

y p

hysi

cian

s an

d or

der

verifi

catio

n by

pha

rmac

ists

Neg

ativ

e si

de-e

ffect

s of

in

stitu

ting

BCM

A21

-hob

serv

atio

nbe

fore

inte

rven

tion

60 h

aft

erin

terv

entio

n

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Spen

cer

et a

l

2005

30

III-3

QS

711

Clin

ical

im

por

tanc

e no

t es

timab

leR

not

estim

able

Teac

hing

ho

spita

ls

NC

U

SA

Befo

re a

ndaf

ter

tria

lPa

tient

s fr

om

gene

ral m

edic

al

units

and

crit

ical

ca

re s

tep

-dow

n un

its

Pre

sta

ndar

d or

derin

gpr

oced

ure

Han

dwrit

ten

orde

rs

by t

he p

hysi

cian

ent

ered

into

th

e p

harm

acy

com

put

er sy

stem

by

the

pha

rmac

y st

aff

Post

C

POE

syst

em

Med

icat

ion

erro

rs

cate

goris

ed b

y er

rors

in

the

pro

cess

of

orde

ring

di

spen

sing

or

adm

inis

terin

g a

med

icat

ion

rega

rdle

ss o

f w

heth

er t

he

pot

entia

l for

inju

ry w

as

pre

sent

15 m

onth

sPr

e 8

and

11

mon

ths

on 2

uni

ts

desi

gnat

ed

for

CPO

E an

d 8

mon

ths

for

all o

ther

un

its n

ot

desi

gnat

ed

for

CPO

EPo

st

2 un

its u

sing

C

POE

follo

wed

fo

r 7

and

4 m

onth

s w

ith a

ll ot

her

units

w

ithou

t C

POE

follo

wed

for

a

furt

her

7 m

onth

s

Stud

yLe

vel o

f ev

iden

ceA

pp

rais

al

scor

eLo

catio

nSt

udy

desi

gnSt

udy

pop

ulat

ion

Inte

rven

tion

Out

com

es(s

) as

sess

edLe

ngth

of

follo

w-u

p

BCM

A

bar

code

med

icat

ion

adm

inis

trat

ion

CPO

E c

omp

uter

ised

phy

sici

an o

rder

ing

entr

y Q

S q

ualit

y sc

ore

R

rele

vanc

e R

N

regi

ster

ed n

urse



Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Appendix III


Appendix IV




















Searchnumber



Appendix V


Australia




Austria


Canada









Denmark


Finland


France




Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Germany



The Netherlands


New Zealand


Norway


Spain



Sweden


Switzerland


United Kingdom





United States




Appendix VI












Source NHMRC 20007




Rank Score 4


Source NHMRC 20007























Rank Score 4


Source NHMRC 20007





















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