Technology and pediatric patient safety: what to target is the dilemma

Risk factors for adverse drug reactions in pediatric inpatients: a systematic review

BACKGROUND

The main objective of the present systematic review is to identify potential risk factors for adverse drug reactions (ADRs) through prospective cohort studies in pediatric inpatients.

METHODS

The data search was done in the following electronic databases PubMed/MEDLINE; Scopus; LILACS and Web of Science from the earliest record until 31 May 2015. Two reviewers independently screened each study and one of them assessed the methodological quality according to the Newcastle-Ottawa scale for cohort studies. The data extraction was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative for cohort studies.

RESULTS

The only risk factor observed in all studies was the increase in the number of prescription drugs. However, other factors were identified, such as the increase in the length of stay or the number of low- or high-risk drugs prescribed, use of general anesthesia and oncological diagnosis. The cumulative incidence of ADR was 16.4% (95% confidence interval: 15.6 to 17.2). The main professional responsible for ADR identification was the pharmacist and the dominant category among the ADRs were gastrointestinal disorders. In addition, analgesics, antibacterial agents and corticosteroids were the drug classes commonly associated with ADRs. The methodology used in this study was tried to homogenize the data extracted; however, this was not sufficient to correct the discrepancies so it was not possible to perform a meta-analysis.

CONCLUSIONS

The increase in the number of prescription drugs was the main risk factor in this population. However, additional studies are required to identify the risk factors for ADRs in pediatric inpatients.

A safe practice standard for barcode technology

OBJECTIVE

Safety advocates have identified barcode verification technology as an important tool to improve health-care practices.

METHODS

We evaluated the evidence for the role of barcode technology in improving a wide range of medication safety outcomes across a broad range of settings. Important implementation issues were highlighted to guide standards for the safe adoption of barcode technology.

RESULTS

Adverse drug events are common, occurring frequently in both inpatient and outpatient settings. Although approximately half of all preventable adverse drug events in inpatients result from medication errors arising from transcription, dispensing, and administration, these errors are far less likely to be caught than in any of the earlier stages of the medication use process and are therefore most amenable to improvement. When integrated with electronic medication administration records, barcode systems are associated with complete elimination of transcription errors. Furthermore, barcode-assisted dispensing systems are associated with 93% to 96% reductions in dispensing errors, and 85% reductions in potential adverse drug events in dispensing. Most studies have reported large and significant reductions in administration errors by up to 80% after implementation of barcode medication administration systems. Although most studies of barcode technology have been conducted in the adult inpatient setting, the limited data available also support their benefit in pediatric and outpatient settings.

CONCLUSIONS

There is growing evidence for the efficacy of barcode solutions in improving overall medication safety. Standards for the implementation of barcode technology are proposed.

Assessment of the reliability of active radiofrequency identification technology for patient tracking in the pediatric emergency department

INTRODUCTION

Radiofrequency identification (RFID) technology has been used in other emergency department settings but has not been assessed in a pediatric emergency department setting for its reliability in its application as a patient tracking system. The goal of this study was to assess the accuracy, precision, and reliability of the technology in a simulated pediatric emergency department setting to collect patient tracking information.

METHODS

A simulated pediatric emergency department clinical assessment room was developed to serve as a test room to collect patient tracking information. This information included the interaction times between simulated patients, parents, physicians, and nurses. Direct observation of these interaction times were recorded by an observer. A patient tracking system based on active RFID technology recorded interaction times between models wearing RFID devices and recorded this information in a computerized data log. Comparison between the direct observation record and the data log was used to determine accuracy, precision, and reliability.

RESULTS

A total of 152 directly observed interactions were recorded. Data extraction from the data log yielded 152 sensor-recorded interactions, resulting in a reliability of 1.0. Data pair comparison on all events resulted in a mean difference of 2.88 seconds.

CONCLUSIONS

Active RFID-based patient tracking systems are a precise and reliable means of recording patient interaction events in the pediatric emergency department.