Adverse events related to drugs occur frequently among inpatients, and many of these are preventable. However, few data available on adverse drug outpatients. We conducted a study determine the rates, types, severity, preventability such outpatients identify preventive strategies.We performed prospective cohort study, including survey patients chart review, at four adult primary care practices in Boston (two hospital-based two community-based), involving total 1202 who received least one...

Newspaper and television stories of catastrophic injuries occurring at the hands clinicians spotlight problem medical error but provide little insight into its nature or magnitude.1 Clinicians, patients, policymakers may underestimate magnitude risk extent harm. We review epidemiology error, concentrating primarily on prevalence consequences which types are most common, make errors, factors that increase likelihood injury from error. #### Summary points The Harvard Australian studies...

Although computerized physician order entry reduces medication errors among inpatients, little is known about the use of this system in primary care.We calculated override rate 3481 consecutive alerts generated at 5 adult care practices that a common for prescription writing. For detailed review, we selected random sample 67 which physicians did not prescribe an alerted and 122 resulted written prescription. We identified factors associated with physicians' decisions to alert, determined...

Oral chemotherapy is emerging as a new option for well-selected patients who can manage potentially complex oral regimens and self-monitor potential complications. If choice between parenteral therapy available, may opt because it more convenient to administer, allows them avoid multiple office visits, gives sense of control over their own cancer care. Whether these advantages are maintained in that combine drugs less clear. The use chemotherapeutic agents profoundly affects all aspects...

Background: Hospitals routinely survey patients about the quality of care they receive, but little is known whether patient interviews can detect adverse events that medical record reviews do not. Objective: To compare reported in postdischarge with detected by review. Design: Random sample survey. Setting: Massachusetts, 2003. Patients: Recently hospitalized adults. Measurements: By using parallel methods, physicians reviewed and records to classify hospital events. Results: Among 998 study...

<h3>Background</h3> Electronic prescribing systems with decision support may improve patient safety in ambulatory care by offering drug allergy and interaction alerts. However, preliminary studies show that clinicians override most of these <h3>Methods</h3> We performed a retrospective analysis 233 537 medication alerts generated 2872 Massachusetts, New Jersey, Pennsylvania who used common electronic system from January 1, 2006, through September 30, 2006. multivariate techniques to examine...

To understand the extent to which hospitalized patients participate in their care, and association of patient participation with quality care safety. Random sample telephone survey medical record review. US acute hospitals 2003. A total 2025 recently adults. Hospitalized reported own assessments overall presence adverse events (AEs) interviews. Physician reviewers rated severity preventability AEs identified by interview chart review among 788 surveyed who also consented Of surveyed, 99.9%...

Objective. The use of administrative data to identify inpatient complications is technically feasible and inexpensive but unproven as a quality measure. Our objective was validate whether screening method that uses from standard hospital discharge abstracts identifies care potential problems. Design. This case-control study with structured implicit physician reviews. Setting. Acute-care hospitals in California Connecticut 1994. Patients. included 1,025 Medicare beneficiaries ≥65 years age....

Although the patient Internet portal is a potentially transformative technology, there little scientific information about demographic and clinical characteristics of enrollees features that they access.We describe two pilot studies comprehensive called PatientSite. These pilots include prospective one-year cohort study all patients who enrolled in April 2003 case-control 2004 nonenrollees at hospital-based primary care practices.The tracked enrollment PatientSite accessed, such as...

Little is known about the prevalence and character of medication-related symptoms in primary care their relationship to adverse drug events (ADEs) or factors that affect patient-physician communication regarding medication symptoms.The study included 661 patients who received prescriptions from physicians at 4 adult practices. We interviewed 2 weeks 3 months after index visit, reviewed patients' medical records, surveyed whose identified symptoms. Physician reviewers determined whether...

<b>Objective</b> To characterise current safety practices for the use of oral chemotherapy. <b>Design</b> Written questionnaire survey pharmacy directors cancer centres. <b>Setting</b> Comprehensive centres in United States. <b>Results</b> Respondents from 42 (78%) 54 eligible completed survey, after consulting with 89 colleagues. Clinicians at 29 used handwritten prescriptions, two preprinted paper and six electronic systems most chemotherapy prescribing. For commonly chemotherapies, on...

Background Evidence suggests that patients can report a variety of adverse events (AEs) not captured by traditional methods such as chart review. Little is known, however, about whether patient reports are useful for measuring safety. Objectives To examine the degree to which physician reviewers agreed "negative effects" constituted AEs, and identify questionnaire items affected reviewers' judgments. Methods We surveyed discharged from Massachusetts hospitals in 2003 elicit information...

<h3>Background</h3> While electronic prescribing (e-prescribing) systems with drug interaction and allergy alerts promise to improve medication safety in ambulatory care, clinicians often override these features. We undertook a study of respondents' satisfaction e-prescribing systems, their perceptions alerts, behavior changes resulting from alerts. <h3>Methods</h3> Random sample survey 300 Massachusetts care who used commercial system. <h3>Results</h3> A total 184 respondents completed the...

OBJECTIVE: As home medication use increases, medications previously managed by nurses are now patients and their families. Our objective was to describe the types of errors occurring in management children with cancer. METHODS: In a prospective observational study at 3 pediatric oncology clinics northeastern southeastern United States, undergoing chemotherapy parents were recruited from November 2007 through April 2011. We reviewed medical records checked prescription doses. A trained nurse...

Contact precautions decrease healthcare worker-patient contact and may impact patient satisfaction. To determine the association between satisfaction, we used a standardized interview for perceived issues with care.Prospective cohort study of inpatients, evaluated at admission on hospital days 3, 7, 14 (until discharged). At each point, patients underwent to identify problems care. After discharge, Hospital Consumer Assessment Healthcare Providers Systems (HCAHPS) survey were administered by...

Background: Efforts to enhance patient-physician communication may improve management of underdiagnosed chronic conditions. Patient internet portals offer an efficient venue for coaching patients discuss conditions with their primary care physicians (PCP). Objectives: We sought test the effectiveness portal-based intervention promote patient-PCP discussion about Research Design: conducted a randomized trial nurse coach entirely through patient internet-portal. Subjects: Two hundred forty-one...

Given the expanding use of oral chemotherapies, authors set out to examine errors in prescribing, dispensing, administration, and monitoring these drugs.Reports were collected chemotherapy-associated medication from a medical literature Internet search review reports Medication Errors Reporting Program MEDMARX. The solicited incident 14 comprehensive cancer centers, also reports, pharmacy interventions, prompted clinician their own center. They classified type incident, severity, stage...

<h3>Background</h3> Because ambulatory care clinicians override as many 91% of drug interaction alerts, the potential benefit electronic prescribing (e-prescribing) with decision support is uncertain. <h3>Methods</h3> We studied 279 476 alerted prescriptions written by 2321 Massachusetts using a single commercial e-prescribing system from January 1 through June 30, 2006. An expert panel reviewed sample common estimating likelihood and severity adverse events (ADEs) associated each alert,...

Background How openly healthcare providers communicate after a medical error may influence long-term impacts. We sought to understand whether greater open communication is associated with fewer persisting emotional impacts, avoidance and loss of trust. Methods Cross-sectional 2018 recontact survey assessing experience in 2017 random digit dial Massachusetts residents. Two hundred fifty-three respondents self-reported error. Respondents were similar non-respondents sociodemographics...