Among nurses at 2 hospitals, the occurrence and frequency of interruptions were significantly associated with the incidence of procedural failures and clinical errors.

BackgroundIntravenous medication administrations have a high incidence of error but there is limited evidence of associated factors or error severity.ObjectiveTo measure the frequency, type and severity of intravenous administration errors in hospitals and the associations between errors, procedural failures and nurse experience.MethodsProspective observational study of 107 nurses preparing and administering 568 intravenous medications on six wards across two teaching hospitals. Procedural failures (eg, checking patient identification) and clinical intravenous errors (eg, wrong intravenous administration rate) were identified and categorised by severity.ResultsOf 568 intravenous administrations, 69.7% (n=396; 95% CI 65.9 to 73.5) had at least one clinical error and 25.5% (95% CI 21.2 to 29.8) of these were serious. Four error types (wrong intravenous rate, mixture, volume, and drug incompatibility) accounted for 91.7% of errors. Wrong rate was the most frequent and accounted for 95 of 101 serious errors. Error rates and severity decreased with clinical experience. Each year of experience, up to 6 years, reduced the risk of error by 10.9% and serious error by 18.5%. Administration by bolus was associated with a 312% increased risk of error. Patient identification was only checked in 47.9% of administrations but was associated with a 56% reduction in intravenous error risk.ConclusionsIntravenous administrations have a higher risk and severity of error than other medication administrations. A significant proportion of errors suggest skill and knowledge deficiencies, with errors and severity reducing as clinical experience increases. A proportion of errors are also associated with routine violations which are likely to be learnt workplace behaviours. Both areas suggest specific targets for intervention.

No abstract

Objective To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas. Design Randomised controlled trial. Setting 47 general practices in Nottingham. Participants 3428 families with children under 5. Intervention A standardised safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks. Main outcome measures Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices. Results No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95% confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years' follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small. Conclusions The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates.

PTSD symptoms mediate the association between IPV and IFN-gamma levels and may partially explain the association of mental health symptoms with physical health sequelae in IPV.

Maternal-fetal attachment (MFA) has been associated with health practices during pregnancy, but less is known about this relationship in low-income women, and no identified studies have examined this relationship to neonatal outcomes. This longitudinal descriptive study was conducted to examine the relationships among MFA, health practices during pregnancy, and neonatal outcomes in a sample of low-income, predominantly African-American women and their neonates. MFA was associated with health practices during pregnancy and adverse neonatal outcomes. Health practices during pregnancy mediated the relationships of MFA and adverse neonatal outcomes. The results support the importance of examining MFA in our efforts to better understand the etiology of health disparities in neonatal outcomes.

(Am J Obstet Gynecol. 2017;216(3):298.e1–298.e11) While obstetric hemorrhage is the most common cause of maternal mortality in the world, it is also the most preventable cause of maternal mortality in the United States. The present study sought to determine whether a tool kit of best practices and implementation strategies for the care of a mother with hemorrhage developed by the California Maternal Quality Care Collective (CMQCC) can reduce severe maternal morbidity (SMM) from obstetric hemorrhage when scaled up to include more than 100 hospitals that collectively care for more than 250,000 births per year.

Intimate partner violence is widespread and results in significant negative mental and physical health outcomes for women. This article is a review of nursing research on intimate partner violence and women's reproductive health and focuses on studies published since 1995, building on prior reviews. We begin with research on forced sex and the resulting physical and emotional trauma as well as implications for contraception, STD/HIV prevention, and condom use negotiation. We then discuss several approaches to the study of abuse during pregnancy, including several studies of nursing interventions. We conclude with the clinical implications of these studies.