Project 4 will examine the effects of hospital stressors and physician reactions to those stressors (""""""""strain"""""""") on medication errors. A hospital, like any workplace, embodies forms of work organization, varying workloads, schedules, and shifts which act as stressors affecting physician performance. In addition, the level of stress experienced by physicians, particularly houseofficers, may be affected by interruptions, fragmentation of information, and challenges to professional autonomy. Thus, project 4 will investigate the effects of workplace stressors and houseofficers' level of strain on the frequency and types of medication errors. This research will suggest interventions in hospitals and other health care settings where similar stressors may affect health care workers and thus increase the risk of medication errors.
The specific aims of this application are: 1. To determine if, and to what extent, the organization of work within a hospital creates workplace stressors that result in medication errors, i.e., do schedules, shifts, workloads, etc., affect houseofficers' commission of medication errors? 2. To determine if houseofficers' experience of workplace stressors (the cognitive, behavioral, physiological, and psychological """"""""strains"""""""") increase the risk of medication errors. 3. To determine how hospital workplace stressors interact with houseofficers' experience of stress (""""""""strain"""""""") to influence the risk of medication errors. 4. To determine how hospital workplace stressors interact with houseofficers' baseline psychological profiles to influence the risk of medication errors. Conducted at the Hospital of the University of Pennsylvania, this study will utilize several research measures, including: 1) synthesis and analysis of houseofficers' workloads, shifts, rotations, on-call status, and schedule data from hospitals-the objective stressors; 2) surveys about houseofficers' experiences of workplace stressors-the subjective stressors; 3) surveys about houseofficers' reactions to those stressors (""""""""strain""""""""); 4) a baseline psychometric personality inventory administered at housestaff orientation; and 5) the outcomes for this study--the rate of """"""""near misses"""""""" for medication errors detected by the Pharmacy Intervention Program conducted by the hospital's Department of Pharmacy Services and supervised by the Drug Use and Effects Committee. Each houseofficer will be evaluated for the numbers of pharmacy interventions regarding his/her prescriptions, using their total number of inpatient medication orders as the denominator. The goal, as with all the projects, is to suggest feasible interventions most likely to reduce medication errors.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Program Projects (P01)
Project #
5P01HS011530-02
Application #
6654217
Study Section
Special Emphasis Panel (ZHS1)
Project Start
2002-09-01
Project End
2003-08-31
Budget Start
Budget End
Support Year
2
Fiscal Year
2002
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Type
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Hennessy, S; Leonard, C E; Localio, A R et al. (2011) Prescriber adherence to pharmacokinetic monitoring service recommendations for aminoglycoside dosing and the risk of acute kidney injury. Int J Clin Pharmacol Ther 49:536-44
Cruess, Dean G; Localio, A Russell; Platt, Alec B et al. (2010) Patient attitudinal and behavioral factors associated with warfarin non-adherence at outpatient anticoagulation clinics. Int J Behav Med 17:33-42
Kim, Michelle M; Metlay, Joshua; Cohen, Abigail et al. (2010) Hospitalization costs associated with warfarin-related bleeding events among older community-dwelling adults. Pharmacoepidemiol Drug Saf 19:731-6
Platt, Alec B; Localio, A Russell; Brensinger, Colleen M et al. (2010) Can we predict daily adherence to warfarin?: Results from the International Normalized Ratio Adherence and Genetics (IN-RANGE) Study. Chest 137:883-9
Hennessy, Sean; Leonard, Charles E; Freeman, Cristin P et al. (2009) CYP2C9, CYP2C19, and ABCB1 genotype and hospitalization for phenytoin toxicity. J Clin Pharmacol 49:1483-7
Haynes, Kevin; Hennessy, Sean; Localio, A Russell et al. (2009) Increased risk of digoxin toxicity following hospitalization. Pharmacoepidemiol Drug Saf 18:28-35
Platt, Alec B; Localio, A Russell; Brensinger, Colleen M et al. (2008) Risk factors for nonadherence to warfarin: results from the IN-RANGE study. Pharmacoepidemiol Drug Saf 17:853-60
Volpp, Kevin G; Loewenstein, George; Troxel, Andrea B et al. (2008) A test of financial incentives to improve warfarin adherence. BMC Health Serv Res 8:272
Leonard, Charles E; Haynes, Kevin; Localio, A Russell et al. (2008) Diagnostic E-codes for commonly used, narrow therapeutic index medications poorly predict adverse drug events. J Clin Epidemiol 61:561-71
Koppel, Ross; Leonard, Charles E; Localio, A Russell et al. (2008) Identifying and quantifying medication errors: evaluation of rapidly discontinued medication orders submitted to a computerized physician order entry system. J Am Med Inform Assoc 15:461-5

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