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Kleefield, Sharon

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Kleefield

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Sharon

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Kleefield, Sharon

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1998 - 199912000 - 20081

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Author's Publications: search.filters.isAuthorOfPublication.94af5f0b-4968-4b13-94ef-5f83cafcb833

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    Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors
    (American Medical Association (AMA), 1998-10-21) Bates, David; Leape, Lucian; Cullen, David J; Laird, Nan; Petersen, Laura A; Teich, Jonathan; Burdick, Elizabeth; Hickey, Mairead; Kleefield, Sharon; Shea, Brian; Vander Vliet, Martha; Seger, Diane L
    Context: Adverse drug events (ADEs) are a significant and costly cause of injury during hospitalization. Objectives: To evaluate the efficacy of 2 interventions for preventing nonintercepted serious medication errors, defined as those that either resulted in or had potential to result in an ADE and were not intercepted before reaching the patient. Design: Before-after comparison between phase 1 (baseline) and phase 2 (after intervention was implemented) and, within phase 2, a randomized comparison between physician computer order entry (POE) and the combination of POE plus a team intervention. Setting: Large tertiary care hospital. Participants: For the comparison of phase 1 and 2, all patients admitted to a stratified random sample of 6 medical and surgical units in a tertiary care hospital over a 6-month period, and for the randomized comparison during phase 2, all patients admitted to the same units and 2 randomly selected additional units over a subsequent 9-month period. Interventions: A physician computer order entry system (POE) for all units and a team-based intervention that included changing the role of pharmacists, implemented for half the units. Main outcome measure: Nonintercepted serious medication errors. Results: Comparing identical units between phases 1 and 2, nonintercepted serious medication errors decreased 55%, from 10.7 events per 1000 patient-days to 4.86 events per 1000 (P=.01). The decline occurred for all stages of the medication-use process. Preventable ADEs declined 17% from 4.69 to 3.88 (P=.37), while nonintercepted potential ADEs declined 84% from 5.99 to 0.98 per 1000 patient-days (P=.002). When POE-only was compared with the POE plus team intervention combined, the team intervention conferred no additional benefit over POE. Conclusions: Physician computer order entry decreased the rate of nonintercepted serious medication errors by more than half, although this decrease was larger for potential ADEs than for errors that actually resulted in an ADE.
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    Health Impact Assessment and Short-term Medical Missions: A Methods Study to Evaluate Quality of Care
    (BioMed Central, 2008) Maki, Jesse; Qualls, Munirih Leona; White, Benjamin; Kleefield, Sharon; Crone, Robert
    Background: Short-term medical missions (STMMs) are a well-established means of providing health care to the developing world. Despite over 250 million dollars and thousands of volunteer hours dedicated to STMMs, there is a lack of standardized evaluation to assess patient safety, quality control, and mission impact. The objective of this project is to design and implement an assessment tool that defines objective parameters of quality of care as identified by STMMs. Methods: The study was conducted in 3 phases: 1) Base-need analysis to determine factors critical to the quality of STMMs, 2) Design of 5 surveys for mission personnel and patients to enable 360-degree evaluation based on factors from phase 1, and 3) Field testing of the surveys with 5 STMMs. Results: An evaluation tool was created assessing 6 major and 30 minor factors identified as important to the quality of STMMs. 5 mission directors, 43 personnel, 10 local hosts, and 55 patients completed the surveys. Of the 6 major measures of quality, missions performed best in Cost (mean score 86%), and Impact (84%). The poorest performance was in Education (64%). Efficiency, Sustainability, and Preparedness showed mean scores of 76%, 77%, and 73%, respectively. Conclusion: Our study provides a novel standardized tool for STMM evaluation. Use of the assessment instrument identified areas of strength and weakness of a particular mission, and delineated general trends in performance compared to other STMMs. We anticipate that the use of this tool may improve the quality of care provided by missions, and stimulate solution-sharing and scholarly discussion among missions.