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Events related to medication errors and related factors involving nurses' behavior to reduce medication errors in Japan: a Bayesian network modeling-based factor analysis and scenario analysis.
Sugimura, Naotaka; Ogasawara, Katsuhiko.
Afiliación
  • Sugimura N; Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.
  • Ogasawara K; Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.
Article en En | MEDLINE | ID: mdl-38858820
ABSTRACT

PURPOSE:

This study aimed to identify the relationships between medication errors and the factors affecting nurses' knowledge and behavior in Japan using Bayesian network modeling. It also aimed to identify important factors through scenario analysis with consideration of nursing students' and nurses' education regarding patient safety and medications.

METHODS:

We used mixed methods. First, error events related to medications and related factors were qualitatively extracted from 119 actual incident reports in 2022 from the database of the Japan Council for Quality Health Care. These events and factors were then quantitatively evaluated in a flow model using Bayesian network, and a scenario analysis was conducted to estimate the posterior probabilities of events when the prior probabilities of some factors were 0%.

RESULTS:

There were 10 types of events related to medication errors. A 5-layer flow model was created using Bayesian network analysis. The scenario analysis revealed that "failure to confirm the 5 rights," "unfamiliarity with operations of medications," "insufficient knowledge of medications," and "assumptions and forgetfulness" were factors that were significantly associated with the occurrence of medical errors.

Conclusion:

This study provided an estimate of the effects of mitigating nurses' behavioral factors that trigger medication errors. The flow model itself can also be used as an educational tool to reflect on behavior when incidents occur. It is expected that patient safety education will be recognized as a major element of nursing education worldwide and that an integrated curriculum will be developed.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Teorema de Bayes / Errores de Medicación Límite: Adult / Female / Humans / Male País/Región como asunto: Asia Idioma: En Revista: J Educ Eval Health Prof Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Corea del Sur

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Teorema de Bayes / Errores de Medicación Límite: Adult / Female / Humans / Male País/Región como asunto: Asia Idioma: En Revista: J Educ Eval Health Prof Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Corea del Sur