Action research in patient safety: The association between pharmacy support and voluntary medication error reporting in critical access hospitals

In Critical Access Hospitals (CAHs), limited technical and human resources, and the low volume of patient care services make assessment and improvement of patient care systems difficult. Medication errors represent failures of an organization's medication use system. Forty percent of CAHs have a pharmacist on site for ten or fewer hours per week. This dissertation used action research---collaboration between an academic medical center and CAHs---to implement a voluntary medication error reporting program in 12 Nebraska CAHs. The goals of the reporting program were to assist the CAHs to disclose errors to patients; to build a culture of safety that valued collecting, analyzing, and learning from information about errors; to implement system change based on the information; and ultimately, to be accountable for the safety of medication use within their facilities.; A quantitative cohort design was nested within the action research methodology. Medication errors voluntarily reported by the CAHs were compared to those reported to MEDMARX(TM)---a national medication error reporting program---by hospitals with pharmacists available 24 hours per day. Hypotheses regarding the association of pharmacy support with the severity, phase, and type of reported medication errors were tested. Limited access to pharmacists in CAHs was associated with reporting smaller proportions of errors that were intercepted before reaching the patient, with reporting smaller proportions of errors originating in prescribing and preparation/dispensing, and with reporting smaller proportions of prescribing, but greater proportions of unauthorized drug, and improper dose/quantity types of errors.; The results of this dissertation inform policy makers about rural patient safety. Fully implementing evidence-based safe medication practices in CAHs will require the alignment of regulatory and legislative drivers to require a pharmacist to review all medication orders, technological interventions to provide access to remote pharmacists, and mechanisms to finance this access. Health services researchers can use action research to assist small rural hospitals to implement evidence-based patient safety practices.