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David Marx

Bio: David Marx is an academic researcher. The author has contributed to research in topics: Probabilistic risk assessment & Risk assessment. The author has an hindex of 2, co-authored 3 publications receiving 12 citations.

Papers
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01 Feb 2005
TL;DR: ST-PRA models can identify systemic and behavioral elements that increase or reduce the risk of wrong-drug, wrong-dose, omitted-dose or drug, and wrong-patient medication administration errors in nursing and CBC facilities.
Abstract: : Objective: State agencies and Oregon's long-term care providers cosponsored this developmental study to explore the creation of two statewide medication system risk models using sociotechnical probabilistic risk assessment (ST-PRA). This paper summarizes the methodology involved in this ongoing project. Methods: A convenience sample of 18 facilities participated. Seven multidisciplinary modeling teams used process mapping, control system mapping, modified failure modes and effects analysis, and ST-PRA to create consolidated ST-PRA models, one for nursing facilities and one for community-based care (CBC) i.e., residential care/assisted living facilities. Discussion: The models provide contextual maps of the errors and behaviors that lead to medication delivery system failures, including unanticipated risks associated with regulatory practices and common deviations from policies and procedures. Policymakers, regulators, and managers can identify, prioritize, and prospectively model risk reduction interventions using ST-PRA. Conclusion: ST-PRA models can identify systemic and behavioral elements that increase or reduce the risk of wrong-drug, wrong-dose, omitted-dose or drug, and wrong-patient medication administration errors in nursing and CBC facilities.

9 citations

Book ChapterDOI
01 Jan 2004
TL;DR: This paper explores the emerging process of socio- technical probabilistic risk assessment (ST-PRA) that is being used by operational managers to identify and mitigate operational risks within complex socio-technical systems such as aerospace and healthcare.
Abstract: Probabilistic risk assessment (PRA) is not new to the system designer. To the operational manager, however, PRA is virtually unknown. This paper explores the emerging process of socio-technical probabilistic risk assessment (ST-PRA) that is being used by operational managers to identify and mitigate operational risks within complex socio-technical systems such as aerospace and healthcare. What are the strengths of modeling socio-technical risks using fault trees, and what are the limitations of fault trees and the probability estimates inherent in probabilistic risk assessment?

3 citations

Book ChapterDOI
01 Jan 2004
TL;DR: In 1999, the Institute of Medicine released its watershed report that put the public on notice of the 44,000 to 98,000 deaths in US hospitals arising from errors in hospitals each year.
Abstract: In 1999, the Institute of Medicine released its watershed report that put the public on notice of the 44,000 to 98,000 deaths in US hospitals arising from errors in hospitals each year. In partial response, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has required each accredited hospital to conduct at least one proactive risk assessment annually. JCAHO recommended Failure Modes and Effects Analysis (FMEA) as one tool for conducting this task.

Cited by
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Journal ArticleDOI
TL;DR: The risk models define thousands of ways process failures and behavioral elements combine to lead to PADEs, and this level of detail is unavailable from any other source.
Abstract: Objectives To determine whether sociotechnical probabilistic risk assessment can create accurate approximations of detailed risk models that describe error pathways, estimate the incidence of preventable adverse drug events (PADEs) with high-alert medications, rank the effectiveness of interventions, and provide a more informative picture of risk in the community pharmacy setting than is available currently. Design Developmental study. Setting 22 community pharmacies representing three U.S. regions. Participants Model-building group: six pharmacists and three technicians. Model validation group: 11 pharmacists; staff at two pharmacies observed. Intervention A model-building team built 10 event trees that estimated the incidence of PADEs for four high-alert medications: warfarin, fentanyl transdermal systems, oral methotrexate, and insulin analogs. Main outcome measures Validation of event tree structure and incidence of defined PADEs with targeted medications. Results PADEs with the highest incidence included dispensing the wrong dose/strength of warfarin as a result of data entry error (1.83/1,000 prescriptions), dispensing warfarin to the wrong patient (1.22/1,000 prescriptions), and dispensing an inappropriate fentanyl system dose due to a prescribing error (7.30/10,000 prescriptions). PADEs with the lowest incidence included dispensing the wrong drug when filling a warfarin prescription (9.43/1 billion prescriptions). The largest quantifiable reductions in risk were provided by increasing patient counseling (27–68% reduction), conducting a second data entry verification process during product verification (50–87% reduction), computer alerts that can't be bypassed easily (up to 100% reduction), opening the bag at the point of sale (56% reduction), and use of barcoding technology (almost a 100,000% increase in risk if technology not used). Combining two or more interventions resulted in further overall reduction in risk. Conclusion The risk models define thousands of ways process failures and behavioral elements combine to lead to PADEs. This level of detail is unavailable from any other source.

29 citations

Journal ArticleDOI
TL;DR: A theoretical model for reducing medication delivery errors and a set of workflow design rules for healthcare professionals to continuously reduce medication Delivery errors are presented.
Abstract: Medication errors are major safety concerns in all hospital settings. The insufficient knowledge about managerial and process improvement strategies required to reduce medication errors can be considered as one of the most important factors holding back hospitals from achieving the desired goals for patient safety. However, strategies for medication error reduction cannot be successfully implemented without a clear understanding of factors affecting medication delivery errors. This paper presents a study in which healthcare professionals’ perceptions on three factors, namely (1) technical complexity of tasks/connections; (2) resources problems; and (3) qualification of human resources, are analyzed within the medication delivery system at one community hospital. The outcomes of this research are a theoretical model for reducing medication delivery errors and a set of workflow design rules for healthcare professionals to continuously reduce medication delivery errors.

22 citations

Journal ArticleDOI
TL;DR: A systematic review of the literature reporting root causes of WSS was performed and a fault tree analysis was performed to assess the reliability of the system in preventing WSS and identifying high-priority targets for interventions aimed at reducing WSS.

18 citations

Book ChapterDOI
01 Jan 2004
TL;DR: The use of Probabilistic Risk Assessment (PRA) has often been an accepted safety research tool in studying risk in technical systems, it has had limited use in predominately human systems in which human limitations and failure represent substantial risks as mentioned in this paper.
Abstract: Government research agencies can play an important role in helping to shape a research agenda through the research methods and techniques that they fund through grants and contracts. While the use of Probabilistic Risk Assessment (PRA) has often been an accepted safety research tool in studying risk in technical systems, it has had limited use in predominately human systems in which human limitations and failure represent substantial risks. There is a need to apply PRA to more human based systems where the role of human behavior can represent a substantial portion of probable risk Two U.S. federal governmental research agencies are now using socio-technical probabilistic risk assessment as an important research tool to meet program objectives as part of their overall safety research efforts. The Agency for Healthcare Research and Quality (AHRQ) is the federal agency designated to lead the research effort in the area of medical error and patient safety while the National Aeronautics and Space Administration has responsibility in research in aviation and space safety management. Both AHRQ and NASA are advancing the use of probabilistic safety assessment through active research programs which are described.

14 citations

Journal ArticleDOI
TL;DR: A Coloured Petri Net (CPN) modelling technique for analysing the reliability and efficiency of a community pharmacy dispensing process is presented, which is a novel method for considering reliability and Efficiency in a single simulation based model.

10 citations