The purpose of the research, Rates of medicine mistakes among down and burnt out occupants: prospective cohort survey by Fahrenkopf, A M et Al. is clearly stated with clear background to the survey in the “ Introduction ” subdivision. The survey aimed “ to find the prevalence of depression and burnout and whether a relation exists between these upsets and medicine mistakes ” in pediatric occupants. Although the rates of depression and burnt outs in occupants have been extensively studied but ne’er has these two factors been quantified consistently against medicine mistake rates hence doing this research an original piece of work. The writers did non declare any struggle of involvement that may bias their research methodological analysis or decisions. However, the rubric of the paper is misdirecting as it suggests that it applies to all occupants but the writers are merely concentrating on pediatric occupants. Furthermore hypothesis of this survey was non clearly presented.
What did they make?
This primary survey was carried out in the signifier of cohort survey dwelling of two control groups of non-depressed and non-burnt out pediatric occupants from three different infirmaries from mid-May through the terminal of June 2003. However, research workers did non clearly warrant why the survey was conducted merely in these “ three urban freestanding kids ‘s infirmary ” and why informations from intensive attention units or ambulatory scenes were non included in the survey. Furthermore, there was a four twelvemonth spread from the clip of research to that of printing this paper in 2008. The consequences derived may non to the full applicable as there may hold been alterations in the environment in which occupants are in which brings about a demand for new research to determine the findings.
From the direction of namelessness and confidentiality of occupants ‘ individuality it can be seen that the writers had carried out the survey with strict control. Furthermore, medicine mistake informations extractors used were incognizant of the on-going survey which farther minimizes possible prejudice that may originate during the aggregation of mistakes. However, the writers besides informed the participants “ the lone case in which confidentiality would be brokenaˆ¦if they were an immediate danger to themselves or others – that is, showed self-destructive or murderous ideation ” and this poses a possible prejudice where participants may under study if they were of all time in such a state of affairs.
Although both the quantitative and qualitative tools used in the survey through the usage of well-established questionnaires matched the survey nonsubjective and was suited for the survey design, the executing of the questionnaires for depression and fire out, in my sentiment, could hold been done better with proper psychiatric rating to minimise any prejudice from the occupants as they may either under study or over report their ain status. The writers besides did non reference when these two questionnaires were completed, the frequence of which they were done by the occupants and how they eventually came to the figure of burned out or down occupants.
What did they happen?
The survey found that down occupants are significantly more likely to do medicine mistakes as opposed to their non-depressed equals while burnt out was found to hold no association with medicine mistake rates. Consequences are by and large clearly reported but with some ambiguity one of the tabular arraies ( Table 2 ) provided. The writer portrayed the informations collected in the signifier of two tabular arraies and to give a diagrammatic representation of their findings, the informations were so set in four saloon graphs showing per centum with P-value. However, information in Table 2 for “ Entire mistakes per occupant, by class ” was presented mistakenly as it included site 3 ‘s occupants under nothing mistakes when they did non hold the informations on medicine mistake linked to the participants for that site which may do misunderstanding to readers at first glimpse.
The decisions derived can non be generalized to the whole pediatric occupant population even though consequences show that the survey population was valid to fulfill the aim of the survey. The sample size and scene are unequal to claim that the findings represent the whole of pediatric occupants because the survey was merely done in urban freestanding kids ‘s infirmaries and the figure of down occupants were excessively little ( n=24 ) doing the consequences and p-value statistically important but equivocal.
Regardless, the research was carried out as intended and the purposes of the paper achieved.
So what?
Regardless of the statistical significance, the consequences are clinically of import as it highlights the significance of depression in relation to medication mistake rates which may finally take to patient safety concerns.
Several reasonable and realistic suggestions for farther research were proposed but they were non elaborated in great inside informations. The writers stated that the more research is required to “ specify better how depression and burnout affect occupants and patient attention in other fortes and to specify better the insouciant relation between depression and mistakes ”
The writers besides acknowledge their restrictions in great inside informations during in the “ Discussion ” session foregrounding that they were clearly cognizant of the jobs within the survey.
The survey besides adds usefully to bing cognition as it is the first to quantify the effects of down occupants to the rate of medicine mistakes and had shown that down occupants are significantly more likely to do medicine mistakes. However, it should be noted that this survey may non generalizable as it is done merely in three urban free standing kids ‘s infirmary therefore it did non account for the discrepancy in work load in different fortes and vicinity.
Bibliography
Fahrenkopf, A M et Al. ( 2012 ) .A Ratess of medicine mistakes among down and burnt out occupants: prospective cohort study.Available: hypertext transfer protocol: //www.bmj.com/content/336/7642/488. Last accessed 12th Dec 2012.
Trisha Greenhalgh ( 2010 ) .A How to read a paper. 4th erectile dysfunction. Chichester: Wiley. p31-60.
Part 2
A Report to the Minister of Health of Malaysia
A survey on “ Ratess of medicine mistakes among down and burnt out occupants: prospective cohort survey ” by Fahrenkopf, A M et Al.
A brief sum-up of the survey:
This survey is carried in the United States by 9 research workers on 123 pediatric occupants across 3 kids ‘s infirmary to happen out if there is a relationship between depression and burnout to the rates of medicine mistakes. The writers identified down pediatric occupants are significantly more likely to do medicine mistakes whereas burnt out has no association to the rate of medicine mistakes.
Key messages derived from the survey:
High prevalence of burnt outs and depression among pediatric occupants
The survey found that burnt out affected 75 % of the pediatric occupants and 20 % of the occupants were at high hazard for depression. Of the down occupants, an dismaying 96 % were besides burnt out.
Depressed occupants made more than 6 times more medicine mistakes than their equals.
Harmonizing to the survey, “ Depressed occupants in pediatricss made more than six times the mistakes in medicine than their non-depressed co-workers ” whereas burnt out had no association to the rates of medicine mistakes made. This calls for concern to patient safety as down occupants may potentially increase the figure of preventable patient mortality.
Poor wellness and occupation public presentation evaluations
Health and occupation public presentation evaluations conducted in the survey showed that both down and burnt out occupants scored significantly poorer. Depressed occupants were significantly more likely to describe their wellness as hapless, working in an impaired status more than twice in the old month and to describe hard concentrating at work. Burn out occupants on the other manus are significantly more likely to describe trouble concentrating on work and being worried that they are depressed.
Sleep want may play a function in incidence of medical mistake
Harmonizing to the survey, 47.2 % of all pediatric occupants studied reported to hold made “ important ” medical mistake due to kip want. This shows that the deficiency of slumber may impair the opinion of occupants and this call for concerns sing overworked occupants ‘ and their ability to supply quality attention for patients without compromising patient ‘s safety.
Deductions of this survey:
Bettering working conditions
With about half the occupants describing that they had made important medical mistake due to kip want, the figure of work hours occupants are made to travel through at any point in clip should be reviewed to guarantee that occupants are able to supply quality attention at no via media to patient safety. As with the Health Facts 2012 released by the Ministry of Health, the current physician to patient ratio is now 1:791. A decrease in this ratio may help to distribute the work load more equally across the board which will take to a possible decrease in work hours and finally understating the degree of medical mistakes made due to kip want.
Regular mental wellness showings for occupants
With such a high prevalence in depression and fire out amongst occupants, regular mental wellness showing will assist guarantee that occupants who are confronting any signifier of upsets seek intervention early so as to cut down any possible side effects that may impact their ability to execute and at the same clip uphold patient safety so that medicine mistakes may be minimised to a lower limit.
Further research on depression and fire out effects on occupants ‘ rate of medicine mistake in Malaya
As the research was conducted in USA, the difference in vicinity and working environment could hold presented a different set of work stressors to the pediatric occupants at that place. A research conducted locally for the occupants in Malaysia will assist determine the effects of these upsets and besides assist place the cardinal countries for betterment to understate the incidence of preventable patient mortality caused by down or fire out occupants.