Can you please do a  summary of his research article below?  I couldn’t attach it I had to copy& pas

Can you please do a  summary of his research article below?  I couldn’t attach it I had to copy& paste it.  Explanation: Summary of Research problem; Description of the research process; Results of the studyThank you      Pediatric Medication Errors and Reduction  Strategies in the Perioperative Period Jennifer L. Bekes, MS, CRNA Courtney R. Sackash, MS, CRNA Ashley L. Voss, MS, RN Christopher J. Gill, PhD, MBA, CRNA  Anesthesia providers are regularly responsible for  assessing, diagnosing, and determining pharmacologic  treatment of a problem. This critical workflow often  includes medication preparation. Decision making in  anesthesia frequently requires rapid intervention, and  caring for the pediatric population poses additional  challenges, such as needing to quickly calculate the  weight-based dosing of medications. The objective of  this review article was to identify and describe themes  related to pediatric medication errors associated with  anesthesia. Additional goals of the review consisted  of identifying and comparing various error reduction  strategies with a primary goal of communicating the  most effective methods to reduce medication errors  in the pediatric population. Screening criteria were  set, and 17 published scholarly articles meeting inclu According to the US Food and Drug Administration(FDA), medication errors cause an estimated 1.3 million injuries each year in  the United States, accounting for 1 death  every day.1 Medication error is defined as  “failure in the drug to treatment process that leads to,  or has the potential to lead to, harm to the patient and  includes an act of omission or commission (drug not  administered or administered late), substitution (incor rect drug administered instead of intended drug), repetition (extra dose of intended drug given), incorrect dose  (incorrect concentration, amount, or rate of infusion of  the drug administered), insertion (drug administered  that was not attended at that time or at any stage), and  incorrect route.”2 Medication errors are of concern in  the pediatric population due to the devastating implica tions for patients and are more likely to be life threaten ing in the pediatric population than in most adults. The  increased risk in the pediatric population is due to the  underdevelopment of their metabolism, which can affect  medication clearance. Also, because of children’s smaller  size, the need for meticulous calculation for weight-based  dosing can lead to medication errors.3 Medication errors  not only can have devastating effects on the patient but  also can have distressing effects on the provider. Periop erative medication errors in the pediatric population by  sion criteria were evaluated using a systematic pro cess. Common themes found leading to medication  errors were incorrect dosing, incorrect medication,  syringe swap, wrong patient, and wrong dosing inter val. The most valuable and sustainable error reduction  strategies found were standardized labeling, prefilled  syringes, and 2-person medication checks. It is believed  that this review will expound on the factors that can  be controlled or minimized to decrease the incidence  of anesthesia-related pediatric medication errors and  facilitate implementation of risk mitigation strategies  immediately into clinical practice. Keywords: Anesthesiology, intraoperative pediatric med ication errors, pediatric anesthesia errors, pediatric drug  errors, pediatric medication error reduction strategies. anesthesia providers are a major concern, and reduction  strategies are an ongoing challenge.  To formulate strategies to help reduce the occurrence  of medication errors, one needs to first identify the most  common perioperative medication errors. The purpose of  this study was to perform a narrative literature review to  characterize the frequency, type, and outcome of anesthe sia medication errors among pediatric patients over the  past 10 years. In this review we also sought to describe  successful error reduction strategies described in the lit erature. Our research questions were: What are the main  types of medication errors in the pediatric population aged  1 day to 18 years in the perioperative period? What miti gation strategies have had the best outcomes that can be  implemented in our current anesthetic pediatric practice? Methods We conducted a narrative literature review on the topic  of perioperative medication errors and reduction strate gies in the pediatric population by anesthesia provid ers. Multiple search engines were used to find articles  pertinent to this topic, including PubMed, Cumulative  Index to Nursing and Allied Health Literature (CINAHL),  Google Scholar, MEDLINE, the Cochrane Library, and  ClinicalKey databases. We considered relevant articles  published between January 1, 2009, and July 15, 2019.  www.aana.com/aanajournalonline AANA Journal ? August 2021 ? Vol. 89, No. 4 319 Figure. PRISMA Flow Diagram Abbreviations: CINAHL, Cumulative Index to Nursing and Allied Health Literature; PRISMA, Preferred Reporting Items for Systematic  Reviews and Meta-Analyses. We defined perioperative period using the definition of  Goodman and Spry4: “The perioperative period begins  when the patient is informed of the need for surgery, in cludes the surgical procedure and recovery, and continues  until the patient resumes his or her usual activities. The  surgical experience can be segregated into three phases:  (1) preoperative, (2) intraoperative, and (3) postop erative. The word ‘perioperative’ is used to encompass all  three phases.” Study inclusion criteria consisted of a target  population from 1 day to 18 years of age, articles printed  in the English language, full-text publications, with medi cation errors and medication error reduction strategies  performed by anesthesia providers and occurring in the  perioperative period. Exclusion criteria included studies  not published in English, not a full-text publication, did  not take place in the perioperative period, did not involve  the pediatric population of our specified age range, and  did not involve anesthesia providers.  We identified search terms relevant to pediatric medi cation errors and reduction strategies perioperatively.  The following search query was adapted to each database  and was used to retrieve articles: pediatric medication  errors AND pediatric medication reduction strategies AND  pediatric perioperative medication errors AND pediatric  anesthesia errors AND intraoperative pediatric medication  errors. After our original search found 17 articles that  met the inclusion criteria, we manually searched the  references from the most applicable articles. Articles that  were not published within the last 10 years, took place  outside the perioperative phase, or did not relate to pedi atric anesthesia were excluded. After these articles were  excluded, our search generated 18 articles.  The articles were scored using the Critical Appraisal  Skills Programme Qualitative Checklist.5 This tool was  chosen because it breaks down the methodologic ap proach to qualitative research into 10 detailed questions,  which we used as a guide to thoroughly determine the  quality of each article. There were 10 questions used to  score each article on its quality. If the question was an swered “yes” a score of 1 was given, “can’t tell” was given  a zero, and “no” was given a zero. If the article achieved  a score of 5 of 10, the article was considered of sufficient  quality. After scoring each article, 1 was discarded, yield ing 17 remaining articles. Data were extracted on the  setting, intervention, problem, and major findings as sociated with pediatric medication errors with reduction  strategies in the perioperative period involving anesthesia  providers. A PRISMA flow diagram represents an illustra tive flow of the references analyzed in the development  of our narrative literature review (Figure). Finally, the 17  articles were reviewed and organized into themes. Results A summary of the medication errors evaluated is in cluded in Table 1. A summary of the most common error  reduction strategies appears in Table 2. • Data Analysis. We first determined each medica tion error discovered in each article and then calculated   320 AANA Journal ? August 2021 ? Vol. 89, No. 4 www.aana.com/aanajournalonline Example of Examples identified in Percentage of each error  medication errors original texts compiled from our research Incorrect dose Dilution errors, calculation errors, incorrect interval 77 Incorrect medication Phenylephrine vs ondansetron, similar looking ampules, 35   similar sounding names Syringe swap Same color syringe, same size, same design, 29   neostigmine vs succinylcholine Inappropriate medication labeling No label, no name, no concentration, wrong units, 17   illegible, content differs from label, inconsistent label   location, similar labeling Known allergen Distraction, interruption, fatigue 6 Table 1. Medication Errors in Pediatric Population During Perioperative Period Example of error Percentage of effective error reduction  reduction strategy strategies compiled from our research Standardized labeling 65 Prefilled syringes 53 Two-person check 41 Drug library/electronic-based references 35 Quality improvement safety analytics 35 Pharmacy support 29 Computer check system 24 Educating staff 17 Standardized anesthesia workspace 12 Zero-tolerance philosophy 12 Checklist 6Table 2. Medication Error Reduction Strategies in Pediatric Population During Perioperative Period  a percentage to determine which errors occurred most  often. After a review of the articles in our study, 70%  (12 of 17 articles) reported medication errors involv ing incorrect dosing,1-3,6-14 35% (6/17) were related to  incorrect medication,2,3,8,10,15,16 29% (5/17) were related  to syringe swap,1,6,10,11,16 17% (3/17) were inappropriate  medication labeling,2,11,15 and 6% (1/17) were related to  a known allergen3 (see Table 1). The causes of the incorrect dosing were noted to be  from incorrect dilution of a medication and errors in  calculation of the dose. In regard to children, calculating  the proper weight-based dose is critical, and the errors  from miscalculation can be fatal. The primary cause of  syringe swap was having a medication manufactured  with similar labels. Various medications have the same  color and design, such as ondansetron and phenyleph rine. The outcome of swapping these medications can be  and has proved to be fatal. For example, an 11-year-old  boy underwent general anesthesia to drain an abscess of  the ankle.10 While the patient was under anesthesia, the  anesthesia provider administered what was thought was  ondansetron; however, the provider mistakenly adminis tered a concentrated 1-mL ampule of phenylephrine. As  a result, this patient experienced a fatal heart arrhyth mia following the administration of the phenylephrine.  Unfortunately, these vials look similar and were mistaken  for one another, which cost a life in this tragic instance.10 High stress, fatigue, and distractions are found to be con tributing factors that also can cause medication errors.  • Outcome Measures. Our outcome measures in cluded the common themes found among the most  common medication errors made. One of the most  common themes found among medication errors was  incorrect dosing of the medication due to calculation  errors. Calculation errors were found to most frequently  occur during the dilution of a medication. The second  most common theme found was the administration of  an incorrect medication. For example, ondansetron  and phenylephrine have similar-appearing vials, which  may cause one to be administered instead of the other,  intended medication, ultimately leading to a medication  error.10 The remaining common themes found leading  to medication errors were syringe swap, wrong patient,  and wrong dosing interval.2 This information, along with  identified characteristics that make the pediatric popula tion most at risk, led to the formulation and implementa tion of medication error reduction. The implementation  of medication error reduction strategies was evidenced to  help reduce medication errors and improve safety in the  pediatric population.  www.aana.com/aanajournalonline AANA Journal ? August 2021 ? Vol. 89, No. 4 321  Our outcome measures also included the various  medication error reduction strategies that were imple mented in each study. From the literature review, stan dardized labeling was found to be the most effective error  reduction strategy,2,6,8-13,15-17 followed by prefilled sy ringes.2,3,7,8,10,12-14,17 Other error reduction strategies in cluded 2-person check,2,3,10,11,13,14,17 using a drug library/ electronic-based references,2,3,7,8,12,17 using quality im provement and safety analytics,3,6,8,17-19 using pharmacy  support,3,6,7,10,13 using a computer check system,3,8,15,16 articles educating staff,2,17,19 using a standardized anesthe sia work space,11,17 using a zero-tolerance philosophy,3,8 and using a checklist9 (see Table 2). A zero-tolerance  philosophy is generally considered to include a meeting  in which practitioners who have not followed the institu tion’s policy for medication administration can provide  an explanation in an effort to help the team understand  the problems involved. These meetings generally take  place with the chief practitioner and provide opportunity  for the chief to identify potential unsafe behaviors by the  practitioner involved in the incident, which may possibly  lead to consequences. The goal of this philosophy is en suring patient and practitioner safety.3 • Error Reduction Strategies Supported by Literature  Review. Patient safety is of utmost priority, and the  National Academy of Medicine (formerly called the  Institute of Medicine) is seeking strategies to prevent  medication errors from occurring. Although anesthesia  is among the leaders in patient safety, research findings  suggest that high medication error rates in this field  of practice still exist.11 Studies have found medication  errors to be responsible for more than 80% of scenarios  that cause patient harm, and nearly all these scenarios  were considered to be preventable.6 Throughout our research, themes were recognized  describing the various medication errors routinely seen  during the perioperative period. The addition of pharma cy support, a checklist, 2-person verification, pediatric  anesthesia drug library on infusion pumps that includes  dose ranges and forcing functions to double-check the  patient’s weight and appropriate dosages, and a zero tolerance philosophy are some error reductions strategies  that have been executed.1,3,9 Several of these medication  error reduction strategies were implemented throughout  various institutions nationwide and found to be effective.  The most valuable and sustainable error reduction  strategies found were standardized labeling, prefilled  syringes, and 2-person medication checks. Standardized  labeling should be clearly identifiable. One way this can  be achieved is by using a specific color for specific drug  types. An example provided in one of the articles is that  opioid medications were color coded with light-blue  labels.17 An additional way to achieve standardization of  labels is through a distinguishable font. A distinguishable  font includes font size and style for ease of readability. In  addition, having clear organization of the wording on the  label helps providers differentiate between medications.  Label placement is also important, and it was found that  having it lengthwise on the syringe helps improve medica tion identification. By performing lengthwise label place ment, studies have shown that there is likely a reduced  rate of syringe swap and medication errors relating to a  decrease in cognitive load.11 The FDA has changed its  standards over the last decade on the labeling of medica tions. Because of these changes, hospitals are now incor porating bar codes in their labels for all drugs and biolog ics. Incorporating bar codes and medication labels is a  safety measure used to ensure the correct patient receives  the correct medication at the correct time.15 The second most valuable and sustainable error reduc tion strategy was prefilled syringes. According to Shaw  and Litman16: “Prefilled syringes can be prepared either  at the drug manufacturer’s site of production, by a third party medication distribution centre, or by a hospital  pharmacy under similarly accurate and sterile condi tions.” The theory behind prefilled syringes is that they  eliminate errors that come from provider preparation  during the reconstitution and dilution of medications  and they provide the most accurate dose of medica tion. Also, in an emergency situation, prefilling syringes  makes medications more readily accessible and reduces  errors that are associated with providers preparing medi cations under stress. Although higher costs and limited  shelf life are disadvantages to pre-prepared syringes,  the quality controls completed during their preparation  make these medications more precise and help reduce  the rate of medication errors.17 The third valuable and sustainable error reduction  strategy found was performing a 2-person check before  administration of medication. These checks are com pleted by 2 individuals separately confirming the 5 rights  of medication administration. These 5 rights are the right  patient, medication, dose, route, and time. Two-person  checks vs single-person checks were found as an effective  method for preventing medication errors.  Discussion Pediatric medication errors occur in the perioperative  setting for various reasons. Limitations of the studies  include in this review involved data coming from a vol untary reporting system and manual chart review. This  makes it difficult to establish the true rate of medication  errors. Another limitation is implementing these reduc tion strategies at facilities nationwide and not just at spe cific hospitals. These medication errors are most likely  underreported because of the fear of repercussions and  unawareness of errors. Some of the factors that prevent  healthcare providers from reporting medication errors is  the fear of responses from patients, patients’ family, phy sicians, and administration. Specifically, there is fear of  322 AANA Journal ? August 2021 ? Vol. 89, No. 4 www.aana.com/aanajournalonline  a negative attitude being developed toward the provider or the possibility of being sued. Developing a supportive  atmosphere and adopting a no-punishment approach to  medication errors have been shown to help improve self reporting. In addition, a simplified reporting process for  healthcare providers that is easy and convenient to use  has been shown to improve self-reporting. The reporting  of medication errors is important to identify reoccurring  errors so they can be corrected and help improve overall  patient safety.20 Due to these limitations and factors,  the estimate of the frequency of errors is not accurate.  Research has shown an improvement in the incidence  of pediatric medication errors with the implementation  of various error reduction strategies. We believe as more  quality improvement and safety analyses are conducted  regarding pediatric medication errors in the perioperative  setting, the incidence of errors will continue to decline.  After reviewing each article, we found that standardized  labeling was the most effective reduction strategy, followed  by prefilled syringes. The quality controls that are prepared  on pre-prepared, labeled, and sealed syringes that come  from either the pharmaceutical industry or the hospital  pharmacy make the use of that medication more accurate,  effectively reducing medication error rates. The limitation  of pre-prepared syringes is the restricted shelf life and  associated higher costs.17 Another limitation to error re duction is lack of self-reporting. This makes it difficult to  determine the exact cause, how often errors are occurring,  and where the gap lies in working to prevent such errors in  the future. Furthermore, the level of implementation and  acceptance of altering everyday practice with new policies  and recommendations relies on how overburdened the  healthcare providers feel with such changes.17 Additional research needs to be completed regard ing medication error reduction strategies that have been  effective and to find ways to successfully implement  reduction strategies into current everyday practice. The  implementation of these error reduction strategies would  reduce the rate of current errors and prevent new errors,  which would improve the overall quality and safety of the  perioperative environment for the pediatric population. Suggested areas for future work should be based on  using methods for data collection other than self-report ing. Self-reporting leads to inaccurate data due to lack of  providers disclosing their medication errors. A solution  suggested is for providers to report all medication errors,  not only those that cause patient harm. Furthermore,  another recommendation is to have future studies con ducted using a culture of no-blame drug error reporting  and review system. Another method proposed was to use  a retrospective chart review. It is important for the medica tion error reduction strategies discovered to be standard ized and implemented nationwide vs at select individual  hospitals. After implementation of these strategies, further  studies should be performed to see if results can be gen eralized. Additionally, after medication error reduction  strategies are put into effect, if errors continue to occur, it  is suggested to expand research at a more individual basis  regarding provider fatigue, burnout, and supervision.  REFERENCES www.aana.com/aanajournalonline AANA Journal ? August 2021 ? Vol. 89, No. 4 323  AUTHORS  Jennifer L. Bekes, MS, CRNA, is a Wayne State University Nurse Anesthe sia program graduate. She was a student when this article was written and  now practices anesthesia in Bingham Farms, Michigan. Courtney R. Sackash, MS, CRNA, is a Wayne State Nurse Anesthesia  program graduate. She was a student when this article was written and  now practices anesthesia in Mount Clemens, Michigan. Ashley L. Voss, MS, RN, is a Wayne State University Nurse Anesthesia  program graduate. She was a student at the time this article was written. Christopher J. Gill, PhD, MBA, CRNA, is an assistant professor (clinical) in the Wayne State University Nurse Anesthesia program.     Health Science Science Nursing NSG 280 Share QuestionEmailCopy link Comments (0)

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