153 results for Merry, Alan, Journal article

  • Evidence-based strategies for preventing drug administration errors during anaesthesia

    Jensen, LS; Merry, Alan; Webster, Craig; Weller, Jennifer; Larsson, L (2004)

    Journal article
    The University of Auckland Library

    We developed evidence-based recommendations for the minimisation of errors in intravenous drug administration in anaesthesia from a systematic review of the literature that identified 98 relevant references (14 with experimental designs or incident reports and 19 with reports of cases or case series). We validated the recommendations using reports of drug errors collected in a previous study. One general and five specific strong recommendations were generated: systematic countermeasures should be used to decrease the number of drug administration errors in anaesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimised according to agreed standards; syringes should (almost) always be labelled; formal organisation of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered.

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  • A new infusion syringe label system designed to reduce task complexity during drug preparation

    Merry, Alan; Webster, Craig; Connell, H (2007)

    Journal article
    The University of Auckland Library

    A new safety-orientated drug infusion label was studied and was compared with conventional methods by prospectively collecting incident reports from November 1998 to November 2003. Anaesthetists were asked to return an incident form for every anaesthetic (87% response rate), the vast majority indicating that no error had occurred. One error was reported with the use of the new label. However, this was due to an incorrect patient weight being recorded in the notes, and the dose was correct for the information available. Therefore, this data point was not included in the analysis. Seven errors were reported in the calculation of dosage using conventional infusion labels during 18 491 anaesthetics compared with no calculation errors in 10 655 anaesthetics with the new label (p = 0.045, Chi-squared test). Despite the difficulties of demonstrating significant benefit from safety initiatives in medicine, these data suggest that targeted system redesign can be effective inreducing error.

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  • Effective labelling is difficult, but safety really does matter

    Webster, Craig; Mathew, DJ; Merry, Alan (2002-02)

    Journal article
    The University of Auckland Library

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  • Anaesthetists' management of oxygen pipeline failure: room for improvement

    Weller, Jennifer; Merry, Alan; Warman, Guy; Robinson, B (2007)

    Journal article
    The University of Auckland Library

    Oxygen pipeline failure is a rare but potentially catastrophic event which can affect the care of patients throughout an entire hospital. Anaesthetists play a critical role in maintaining patient safety, and should be prepared to support an institution-wide emergency response if oxygen failure occurs. We tested the preparedness for this through observation of 20 specialist anaesthetists to a standardised simulator scenario of central oxygen supply failure. Responses were documented using multiple approaches to ensure accuracy. All anaesthetists demonstrated safe immediate patient care, but we observed a number of deviations from optimal management, including failure to conserve oxygen supplies and, following restoration of gas supplies, failure to test the composition of the gas supplied from the repaired pipelines. This has implications for patient care at both individual and hospital level. Our results indicate a gap in anaesthesia training which should be addressed, in conjunction with planning for effective hospital-wide responses to the event of critical resource failure.

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  • Pulling the plug on ad hoc critical incident training

    Wheeler, DW; Williams, CE; Merry, Alan (2009)

    Journal article
    The University of Auckland Library

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  • Scout's motto

    Baker, Paul; Merry, Alan (2009)

    Journal article
    The University of Auckland Library

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  • The effects of the general anaesthetic isoflurane on the honey bee (Apis mellifera) circadian clock

    Ludin, Nicola; Cheeseman, James; Merry, Alan; Millar, Craig; Warman, Guy (2016)

    Journal article
    The University of Auckland Library

    General anaesthesia administered during the day has previously been shown to phase shift the honey bee clock. We describe a phase response curve for honey bees (n=105) to six hour isoflurane anaesthesia. The honey bee isoflurane PRC is "weak" with a delay portion (maximum shift of -1.88 hours, circadian time 0 - 3) but no advance zone. The isoflurane-induced shifts observed here are in direct opposition to those of light. Furthermore, concurrent administration of light and isoflurane abolishes the shifts that occur with isoflurane alone. Light may thus provide a means of reducing isoflurane-induced phase shifts.

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  • Teamwork, communication, formula-one racing and the outcomes of cardiac surgery

    Merry, Alan; Weller, Jennifer; Mitchell, Simon (2014-03)

    Journal article
    The University of Auckland Library

    Most cardiac units achieve excellent results today, but the risk of cardiac surgery is still relatively high, and avoidable harm is common. The story of the Green Lane Cardiothoracic Unit provides an exemplar of excellence, but also illustrates the challenges associated with changes over time and with increases in the size of a unit and the complexity of practice today. The ultimate aim of cardiac surgery should be the best outcomes for (often very sick) patients rather than an undue focus on the prevention of error or adverse events. Measurement is fundamental to improving quality in health care, and the framework of structure, process, and outcome is helpful in considering how best to achieve this. A combination of outcomes (including some indicators of important morbidity) with key measures of process is advocated. There is substantial evidence that failures in teamwork and communication contribute to inefficiency and avoidable harm in cardiac surgery. Minor events are as important as major ones. Six approaches to improving teamwork (and hence outcomes) in cardiac surgery are suggested. These are: 1) subspecialize and replace tribes with teams; 2) sort out the leadership while flattening the gradients of authority; 3) introduce explicit training in effective communication; 4) use checklists, briefings, and debriefings and engage in the process; 5) promote a culture of respect alongside a commitment to excellence and a focus on patients; 6) focus on the performance of the team, not on individuals.

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  • The WFSA and patient safety in the perioperative setting

    Enright, A; Merry, Alan (2009-01)

    Journal article
    The University of Auckland Library

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  • Use of a new task-relevant test to assess the effects of shift work and drug labelling formats on anesthesia trainees' drug recognition and confirmation.

    Cheeseman, James; Webster, Craig; Pawley, Matthew; Francis, Margaret; Warman, Guy; Merry, Alan (2011-01)

    Journal article
    The University of Auckland Library

    Background Drug administration errors occur in every aspect of clinical practice. Using a novel task-relevant Medication Recognition and Confirmation Test (MRCT), we investigated the effects on performance of working night and day shifts and labelling different drug formats. Methods Anesthesia trainees (n = 18) participated in one of two experiments during an 8-12 hr day shift and an 8-12 hr night shift. In Experiment-1 (n = 10), we compared standardized colour-coded labels with pictures of ampoules. In Experiment-2 (n = 8), we compared colourcoded labels with black and white labels. Sleep was measured with wrist actigraphy during both day and night shift runs over seven to eight days. The MRCT outcome measures were reaction times and drug errors. Results In the two experiments, colour-coded labels were recognized (and therefore selected) more quickly than pictures of conventional ampoules (mean difference 332 msec, 95% confidence interval (CI) 242-422 msec; P\0.0001) and faster than black and white labels (mean difference 96 msec, 95% CI 46-146 msec; P\0.0001). Participants obtained less sleep while working night shifts than while working day shifts (mean difference 57 min, 95% CI 0:15-1:39 hr; P = 0.013). Mean confirmation reaction times were slower during night shifts than during day shifts (mean difference 60 msec, 95% CI 1-120 msec; P = 0.048). No differences in error rates were observed between shifts or among drug label types. Conclusions Label format influenced recognition and confirmation reaction times to representations of drugs in this study, and we found some evidence to suggest that performance is better during day shifts than during night shifts. The task-relevant test evaluated here may have further application in measuring performance in the wider clinical setting.aspect of clinical practice. Using a novel task-relevant Medication Recognition and Confirmation Test (MRCT), we investigated the effects on performance of working night and day shifts and labelling different drug formats. Methods Anesthesia trainees (n = 18) participated in one of two experiments during an 8-12 hr day shift and an 8-12 hr night shift. In Experiment-1 (n = 10), we compared standardized colour-coded labels with pictures of ampoules. In Experiment-2 (n = 8), we compared colourcoded labels with black and white labels. Sleep was measured with wrist actigraphy during both day and night shift runs over seven to eight days. The MRCT outcome measures were reaction times and drug errors. Results In the two experiments, colour-coded labels were recognized (and therefore selected) more quickly than pictures of conventional ampoules (mean difference 332 msec, 95% confidence interval (CI) 242-422 msec; P\0.0001) and faster than black and white labels (mean difference 96 msec, 95% CI 46-146 msec; P\0.0001). Participants obtained less sleep while working night shifts than while working day shifts (mean difference 57 min, 95% CI 0:15-1:39 hr; P = 0.013). Mean confirmation reaction times were slower during night shifts than during day shifts (mean difference 60 msec, 95% CI 1-120 msec; P = 0.048). No differences in error rates were observed between shifts or among drug label types. Conclusions Label format influenced recognition and confirmation reaction times to representations of drugs in this study, and we found some evidence to suggest that performance is better during day shifts than during night shifts. The task-relevant test evaluated here may have further application in measuring performance in the wider clinical setting.

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  • Medication errors: time for a national audit?

    Merry, Alan; Anderson, Brian (2011-11)

    Journal article
    The University of Auckland Library

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  • The challenges of technological intensification

    Webster, Craig; Stabile, M; Merry, Alan (2009)

    Journal article
    The University of Auckland Library

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  • Ethics, Industry and Outcomes

    Merry, Alan (2008-03)

    Journal article
    The University of Auckland Library

    Evidence-based medicine depends on research that is reliable, well conducted, and free of influence from interest groups (which are not confined to industry). There are many ways to influence the outcome of clinical research, and the history of influence in research related to tobacco is illuminating in this regard. Health care depends on industry, and if properly managed, the relationship between industry and medical academia can be symbiotic. Achieving positive outcomes from such relationships depends on ensuring the presence of the elements needed for reasonable independence on the part of investigators, and on understanding the ways in which influence can be exerted over the production and publication of evidence. Regulation cannot substitute for integrity, particularly the integrity of the investigators. Pushing the limits of ethics in research threatens to undermine not only the reputation of those conducting the research but also the standing of science itself.

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  • A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

    Haynes, AB; Weiser, TG; Berry, WR; Lipsitz, SR; Breizat, AS; Dellinger, EP; Herbosa, T; Joseph, S; Kibatala, PL; Lapitan, MC; Merry, Alan; Moorthy, K; Reznick, RK; Taylor, B; Gawande, AA (2009)

    Journal article
    The University of Auckland Library

    Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery.

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  • Interdisciplinary team interactions: a qualitative study of perceptions of team function in simulated anaesthetic crises

    Weller, Jennifer; Janssen, AL; Merry, Alan; Robinson, B (2008)

    Journal article
    The University of Auckland Library

    OBJECTIVES We placed anaesthesia teams into a stressful environment in order to explore interactions between members of different professional groups and to investigate their perspectives on the impact of these interactions on team performance. METHODS Ten anaesthetists, 5 nurses and 5 trained anaesthetic assistants each participated in 2 fullimmersion simulations of critical events using a highfidelity computerised patient simulator. Their perceptions of team interactions were explored through questionnaires and semi-structured interviews. Written questionnaire data and interview transcriptions were entered into N6 qualitative software. Data were analysed by 2 investigators for emerging themes and coded to produce reports on each theme. RESULTS We found evidence of limited understanding of the roles and capabilities of team members across professional boundaries, different perceptions of appropriate roles and responsibilities for different members of the team, limited sharing of information between team members and limited team input into decision making. There was a perceived impact on task distribution and the optimal utilisation of resources within the team. CONCLUSIONS Effective management of medical emergencies depends on optimal team function. We have identified important factors affecting interactions between different health professionals in the anaesthesia team, and their perceived influences on team function. This provides evidence on which to build appropriate and specific strategies for interdisciplinary team training in operating theatre staff.

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  • I. Best practice and patient safety in anaesthesia.

    Weller, Jennifer; Merry, Alan (2013-05)

    Journal article
    The University of Auckland Library

    The pursuit of patient safety involves reducing the gap between best practice and the care actually delivered to patients. Understanding how to reliably deliver best practice care using established anaesthetic techniques may, today, be more important than seeking new ones. Advances in anaesthesia safety involve analysing failures and devising strategies to address these. However, anaesthetists do not work in isolation, and their contribution to the function of the multidisciplinary teams in which they work has far-reaching consequences for patient care.

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  • Curtailing the cost of anesthetic drugs: prudent economics or an infringement of clinical autonomy?

    Merry, Alan; Hamblin, R (2015-10)

    Journal article
    The University of Auckland Library

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  • Health literacy: from the patient to the professional to the system

    Walsh, C; Shuker, C; Merry, Alan (2015-10-16)

    Journal article
    The University of Auckland Library

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  • Public reporting of health care performance data: what we know and what we should do

    Hamblin, R; Shuker, C; Stolarek, I; Wilson, J; Merry, Alan (2016-01)

    Journal article
    The University of Auckland Library

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  • Standardised metrics for global surgical surveillance

    Weiser, TG; Makary, MA; Haynes, AB; Dziekan, G; Berry, WR; Gawande, AA; Sindi, IA; Herbosa, T; Storr, J; Ko, CY; Kozak, LJ; Barraclough, B; Reznick, RK; Taylor, B; Joseph, S; Breizat, A-HS; Merry, Alan; Lapitan, MCM; Donaldson, L; Philip, P; Kibatala, PL; Sayek, I; Darzi, LA; Moorthy, K; Dellinger, EP (2009-10-02)

    Journal article
    The University of Auckland Library

    Public health surveillance relies on standardised metrics to evaluate disease burden and health system performance. Such metrics have not been developed for surgical services despite increasing volume, substantial cost, and high rates of death and disability associated with surgery. The Safe Surgery Saves Lives initiative of WHO's Patient Safety Programme has developed standardised public health metrics for surgical care that are applicable worldwide. We assembled an international panel of experts to develop and define metrics for measuring the magnitude and effect of surgical care in a population, while taking into account economic feasibility and practicability. This panel recommended six measures for assessing surgical services at a national level: number of operating rooms, number of operations, number of accredited surgeons, number of accredited anaesthesia professionals, day-of-surgery death ratio, and postoperative in-hospital death ratio. We assessed the feasibility of gathering such statistics at eight diverse hospitals in eight countries and incorporated them into the WHO Guidelines for Safe Surgery, in which methods for data collection, analysis, and reporting are outlined. © World Health Orgnization 2009.

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