Medication errors observed in 36 health care facilities.

Background: Medication errors are a national concern.

Objective: To identify the prevalence of medication errors (doses administered differently than ordered).

Design: A prospective cohort study.

Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities.

The validity and cost-effectiveness of three methods for detecting medication errors were examined. A stratified random sample of 36 hospitals and skilled-nursing facilities in Colorado and Georgia was selected. Medication administration errors were detected by registered nurses (R.

Consultant evaluation of a hospital medication system: implementation and evaluation of the new system.

The effects of consultant-recommended modifications in a hospital medication system on medication-error rates and response times were evaluated. Fourteen recommendations for improving the medication system in a large teaching hospital were implemented to varying extents over a period of 1.5 years.

Consultant evaluation of a hospital medication system: synthesis of a new system.

Recommendations of consultants for the implementation of a new medication system at a large teaching hospital are described. Based on a previous analysis of the hospital's existing drug distribution and control system that revealed problems in reliability and response time, an interdisciplinary consultant group offered 14 recommendations, which included implementation of a computerized unit dose delivery system and selected clinical pharmacy services. Functions identified for which computerization would produce the greatest benefits included maintenance of patient census data, medication order entry and retrieval, and preparation of a medication administration record for nursing.

Consultant evaluation of a hospital medication system: analysis of the existing system.

A consultant team's evaluation of a system for distributing and controlling medications in a large teaching hospital is described. Through interviews with key personnel from administration, pharmacy, nursing, and the medical staff, an interdisciplinary research group identified problems in the reliability and response times of the hospital's existing medication system. After assessing staff expectations regarding acceptable standards for medication errors and response times and their attitudes toward proposed changes in the medication system, medication-error rates were determined using a pharmacist-observer method.

Medication errors in nursing homes and small hospitals.

An observation method for measuring the rate of medication errors, which can be used as an outcome indicator of a medication system's quality, was evaluated in a national sample of long-term care facilities (LTCFs) and small hospitals. Trained nurse and pharmacist observers observed nurses administer medications during the three-hour period surrounding the peak medication workload on one day in national sample of 58 LTCFs and 10 hospitals. Opportunity-for-errors (OE), defined as the total number of doses ordered plus the unauthorized doses given, were counted, as well as all medication errors.

Research design: general designs.

The conceptual foundations for some of the most widely used research designs are presented, and the various design models are analyzed. Research designs should specify the stimulus and response, the time-order sequence, the sampling and allocation procedures, and the generalized method of analysis. Results of symbolization, seriation, and classification investigations cannot be generalized beyond the study units investigated.

Type I fiber atrophy in the vastus lateralis muscle in dogs with femoral fractures treated by hyperextension.

A syndrome characterized by limb hyperextension, generalized muscle atrophy, abducted gait, and a limited range of joint motion is reported in five dogs, four of which were immature. Distal femoral fractures, of traumatic origin, were found in all dogs; four dogs were subjected to limb immobilization in extension for three to seven weeks. Lesions in muscle biopsies included fiber size variability, increased prominence of subsarcolemmal nuclei, increased perimysial fibrosis and focal necrosis.

Subclinical myopathy associated with hyperadrenocorticism in the dog.

One of seven dogs with clinical signs of hyperadrenocorticism had clinical evidence of neuromuscular disorder. Clinical diagnosis of hyperadrenocorticism was confirmed by plasma cortisol concentrations before and after adrenocorticotrophin hormone and dexamethasone administration. Electromyographic studies showed bizarre, high frequency discharges in all dogs.

Legal implications of the pharmacist's expanded clinical roles: a challenge to the clinical pharmacist's competencies.

Various sources have put forward the pharmacist as a clinician in addition to traditional functions. These expanded duties have been described as being beneficial to the health care system. This paper describes a project involving the clinical judgment and expertise of the doctor of pharmacy.

Quality of pharmaceutical care in hospitals.

The objective of this study was to measure the quality of pharmaceutical services provided to hospital inpatients. Using Donabedian's model, normative standards from the Joint Commission on Accreditation of Hospitals and the American Society of Hospital Pharmacists were used to develop a personal interview schedule to access the structure and process components of pharmaceutical services. To determine the effect of bed size, rural vs.