Data mining technology; hair removal and surgical site infection; cytobrush versus curette sampling; pain wraps - Evidence For Practice

George Allen

Use of data mining tools in medication error analysis

Topics in health information management November 2002

Data mining and machine learning are artificial intelligence technologies that analyze data from different perspectives and summarize it into useful information. The objective of this study was to determine if data mining tools are useful in identifying underlying factors related to medication errors. (1) Incident reports (n = 2,700) from a large urban hospital during a five-year period were analyzed. Errors were classified in relation to the person responsible (ie, nurse, physician, pharmacist) and location where the error occurred (ie, general care, surgery, intensive care, emergency department). Outcome variables assessed were near misses and adverse drug events (ADE) associated with medication errors. Data mining and machine learning technologies were used to analyze these variables.

Findings. Data showed that 80.7% of the medication errors reached patients, and 19.3% were classified as near misses (ie, the error was caught before the medication was given to the patient). Data mining analysis accurately classified 72% of the medication error cases and revealed that the three most important factors in predicting an ADE were type of medication, proximal cause (ie, why), and place where the error occurred. The person responsible, proximal cause, and place were the factors associated with near misses. Additionally, analysis revealed that if procedure was not followed, errors reached patients 93% of the time if a nurse was the responsible person, 68% of the time if a pharmacist was the responsible person, and 75% of the time if a physician was the responsible person. Conversely, if a nurse was responsible and the medication error was the result of miscommunication, an ADE was likely to result 20% of the tune, compared to 55% of the time if a pharmacist was responsible for the medication error.

Clinical implications. This study revealed that data mining tools can identify patterns and relationships that are not easily identified using conventional data analysis. In searching for ways to improve patient safety, perioperative managers must consider the use of techniques such as data mining to identify hidden patterns and underlying factors related to medication errors and other patient safety issues so corrective actions can be developed and implemented effectively.

Hair removal and surgical site infection rates

Otolaryngology--head and neck surgery January 2003

Removal of hair from a surgical site is an identified risk factor for surgical site infection (SSI), and the risk increases when hair is removed by shaving. Despite this fact, hair removal by shaving is a common practice before surgery on the skull. This retrospective study was undertaken to evaluate SSI rates after skull base resections for which hair was not removed. (2) The SSI rate in 175 patients who underwent skull base resections without hair removal was assessed retrospectively and compared to published SSI rates in patients who had undergone similar procedures for which hair was removed.

Findings. The overall SSI rate in the group that did not have hair removed was 1.1% (ie, two SSIs in 175 procedures). This infection rate was equivalent to published SSI rates for similar procedures for which hair was removed.

Clinical implications. The finding of no statistically significant difference in SSI rates between procedures for which hair was removed and procedures for which hair was not removed before skull base surgery is clinically relevant. These results strongly suggest that skull base surgical procedures without hair removal do not carry additional risk for SSI, and they potentially could have a positive impact on the psychosocial well-being of the patient. Perioperative nurses can urge surgeons and other clinicians to reevaluate commonly practiced procedures (ie, sacred cows) including removal of hair before surgical procedures on the skull.

Sleeved cytobrush versus endocervical curette sampling

Obstetrics & gynecology March 2003

Although false negative and false positive results plague the endocervical curette test, it continues to be used by many health care providers in the evaluation of women with abnormal cervical cytology. This randomized study was undertaken to compare endocervical specimens obtained using an endocervical curette to those obtained using a sleeved cytobrush. (3) Both endocervical curette and cytobrush sampling were performed on 62 patients undergoing cervical conization or hysterectomy.

The sampling order was randomized. In one group, cytobrush sampling was performed first, and then an endocervical curette sampling was performed before surgery. In the other group, an endocervical curette sampling was performed first, and then a cytobrush sampling was performed before surgery. Specimens were assessed for adequacy for diagnosis, the presence or absence of neoplasm, and the degree of neoplasm if present. Descriptive statistics were used to analyze differences between the two groups.

Findings. A total of 59 samples obtained using an endocervical curette, 60 samples obtained using a sleeved cytobrush, and 60 surgical specimens were available for analysis. Significantly more inadequate specimens were obtained using an endocervical curette than a sleeved cytobrush (13 out of 59 versus 1 out of 60, respectively; 95% confidence interval [CI] for the mean difference: 9%, 31%). The specificity was 100% for the endocervical curette compared to 88% for the sleeved cytobrush; (relative risk 1.13,95% CI 1.00, 1.28). Use of a sleeved cytobrush was a more sensitive sampling method than use of a curette (odds ratio 2.04, 95%, CI 0.98, 4.22).

Clinical implications. Based on these findings, the sleeved cytobrush sampling technique appears to have a major clinical advantage. Only a small number (2%) of the samples were found to be inadequate compared to 20% when specimens were obtained using curettes. Perioperative nurses in their role as patient advocates can use this data to encourage physicians to consider using the sleeved cytobrush technique when evaluating women with abnormal cervical cytology.

Pain wrap dressing after knee arthroscopy

Orthopedics January 2003

Patients generally experience significant discomfort after some minimally invasive surgical procedures, including routine knee arthroscopy, and they frequently require postoperative narcotics. This study evaluated a pain wrap to determine whether its use reduced postoperative pain, stiffness, warmth, and joint effusion after elective knee arthroscopy. (4) The pain wrap mechanism involves absorbing sodium ions from the skin, thereby inhibiting activity of the nerve endings, resulting in improved pain control. Forty-nine consecutive patients undergoing knee arthroscopy were assigned randomly to a treatment group that received a sterile pain wrap as part of their dressing or a control group that received a standard gauze wrap dressing. Patients were asked to complete a postoperative knee pain assessment form and a postoperative analgesic use form on a daily basis for the first 10 postoperative days. On postoperative day 10, patients returned for suture removal and were assessed for range of motion, swelling, and skin temperature. Descriptive statistics were used to evaluate differences between the groups.

Findings. Twenty-four patients (ie, 12 in each group) completed the study. Although no difference was found in the amount of pain medication used by each group, the treatment group had significantly lower pain scores than the control group (2.2 versus 4.6, P = 0.03). There were no significant differences in postoperative range of motion or swelling; however, skin temperature was significantly lower in the treatment group (1.1[degrees]F [-17.2[degrees]C] versus 3.9[degrees]F [-15.6[degrees]C], P = 0.02).

Clinical implications. Cryotherapy devices currently used to control postoperative pain after knee arthroscopy, are expensive. This study suggests that use of a pain wrap may be a relatively inexpensive alternative to expensive cryotherapy devices. Perioperative personnel should consider directly evaluating pain wraps compared to cryotherapy devices.

NOTES

(1.) W J Rudman et al, "The use of data mining tools in identifying medication error near misses and adverse drug events," Topics in Health Information Management 23 (November 2002) 94-101.

(2.) Z Gil et al, "The role of hair shaving in skull base surgery," Otolaryngology-Head and Neck Surgery 128 (January 2003) 43-47.

(3.) L A Boardman et al, "A randomized trial of the sleeved cytobrush and the endocervical curette," Obstetrics & Gynecology 101 (March 2003) 426-430.

(4.) J K Hayden, B J Cole, "The effectiveness of a pain wrap compared to a standard dressing on the reduction of postoperative morbidity following routine knee arthroscopy: A prospective randomized single-blind study," Orthopedics 26 (January 2003) 59-63.

This information is intended for general use only. The clinical implications are specific to the abstracted article only. Individuals intending to put these findings into practice are strongly encouraged to review the original article to determine its applicability to their setting.

GEORGE ALLEN

RN, PHD, CNOR, CIC

DIRECTOR OF INFECTION CONTROL

DOWNSTATE MEDICAL CENTER

BROOKLYN, NY

COPYRIGHT 2003 Association of Operating Room Nurses, Inc.
COPYRIGHT 2003 Gale Group