Methods for the detection of adverse drug reactions in hospitalized children: a systematic review

Introduction: Adverse drug reactions (ADR) are a problem for healthcare systems worldwide. Pediatric patients constitute a vulnerable group with regard to ADRs. However, although pediatric patients are at increased risk for these reactions, there is little progress on ADR detection methods in this group.Areas covered: In this systematic search, performed according to PRISMA statements, we selected studies, published in PubMed/Medline databases; Scopus; LILACS; Web of Science; Embase and Cochrane Library until April, 2020, on ADRs in hospitalized pediatric patients.Expert opinion: The increase of pediatric drug safety data is essential to the improvement of childcare. Health services must continuously stimulate educational programs focused on ADR detection tools to minimize the barriers and raise awareness among professionals. Therefore, it is necessary to consider that each method has advantages and disadvantages and must be analyzed in detail to be implemented according to the peculiarities of each practice scenario. Triggers tools (active method) correlated with electronic medical notes seems a good strategy for ADR identification, whether pediatric parameters are well checked and adapted with each age group. In any event, combined methods will add data to identification and clearer ADR assessment.

Study of a multisite prospective adverse event surveillance system

Background

We have designed a prospective adverse event (AE) surveillance method. We performed this study to evaluate this method’s performance in several hospitals simultaneously.

Objectives

To compare AE rates obtained by prospective AE surveillance in different hospitals and to evaluate measurement factors explaining observed variation.

Methods

We conducted a multicentre prospective observational study. Prospective AE surveillance was implemented for 8 weeks on the general medicine wards of five hospitals. To determine if population factors may have influenced results, we performed mixed-effects logistic regression. To determine if surveillance factors may have influenced results, we reassigned observers to different hospitals midway through surveillance period and reallocated a random sample of events to different expert review teams.

Results

During 3560 patient days of observation of 1159 patient encounters, we identified 356 AEs (AE risk per encounter=22%). AE risk varied between hospitals ranging from 9.9% of encounters in Hospital D to 35.8% of encounters in Hospital A. AE types and severity were similar between hospitals—the most common types were related to clinical procedures (45%), hospital-acquired infections (21%) and medications (19%). Adjusting for age and comorbid status, we observed an association between hospital and AE risk. We observed variation in observer behaviour and moderate agreement between clinical reviewers, which could have influenced the observed rate difference.

Conclusion

This study demonstrated that it is possible to implement prospective surveillance in different settings. Such surveillance appears to be better suited to evaluating hospital safety concerns within rather than between hospitals as we could not definitively rule out whether the observed variation in AE risk was due to population or surveillance factors.

Implementation of a multimodal patient safety improvement program "SafetyLEAP" in intensive care units

Purpose Patient safety remains a top priority in healthcare. Many organizations have developed systems to monitor and prevent harm, and have invested in different approaches to quality improvement. Despite these organizational efforts to better detect adverse events, efficient resolution of safety problems remains a significant challenge. The authors developed and implemented a comprehensive multimodal patient safety improvement program called SafetyLEAP. The term "LEAP" is an acronym that highlights the three facets of the program including: a Leadership and Engagement approach; Audit and feedback; and a Planned improvement intervention. The purpose of this paper is to evaluate the implementation of the SafetyLEAP program in the intensive care units (ICUs) of three large hospitals. Design/methodology/approach A comparative case study approach was used to compare and contrast the adherence to each component of the SafetyLEAP program. The study was conducted using a convenience sample of three ( n=3) ICUs from two provinces. Two reviewers independently evaluated major adherence metrics of the SafetyLEAP program for their completeness. Analysis was performed for each individual case, and across cases. Findings A total of 257 patients were included in the study. Overall, the proportion of the SafetyLEAP tasks completed was 64.47, 100, and 26.32 percent, respectively. ICU nos 1 and 2 were able to identify opportunities for improvement, follow a quality improvement process and demonstrate positive changes in patient safety. The main factors influencing adherence were the engagement of a local champion, competing priorities, and the identification of appropriate resources. Practical implications The SafetyLEAP program allowed for the identification of processes that could result in patient harm in the ICUs. However, the success in improving patient safety was dependent on the engagement of the care teams. Originality/value The authors developed an evidence-based approach to systematically and prospectively detect, improve, and evaluate actions related to patient safety.

A pre and post intervention study to reduce unnecessary urinary catheter use on general internal medicine wards of a large academic health science center

BACKGROUND

Urinary catheters are a common medical intervention, yet they can also be associated with harmful adverse events such as infection, urinary tract trauma, delirium and patient discomfort. The purpose of this study was to describe the use of the SafetyLEAP program to drive improvement efforts, and specifically to reduce the use of urinary catheters on general internal medicine wards.

METHODS

A pre and post intervention study using the SafetyLEAP program was performed with urinary catheter prevalence as the primary outcome on two general internal medicine wards in a large academic health sciences center.

RESULTS

A total of n = 534 patients (n = 283 from ward #1; and n = 252 from ward #2) were included in the initial audit and feedback portion of the study and 1601 patients (n = 824 pre-intervention and n = 777 post-intervention were included in the planned quality improvement portion of the study). A total of 379 patients during the quality improvement intervention had a urinary catheter. Overall, the adherence to the SafetyLEAP program was 97.4% on both general internal medicine wards. The daily catheter point prevalence decreased from 22 to 13%. After the implementation of the program, the urinary catheter utilization ratio (defined as urinary catheter days/patient days) declined from 0.14 to 0.12. Catheter-associated urinary tract infections (CAUTI) were unchanged.

CONCLUSION

The SafetyLEAP program can help provide a systematic approach to the detection, and reduction of safety incidents. Future studies should aim at refining and implementing this intervention broadly.

Routine quality care assessment of schizophrenic disorders using information systems

Objective

To assess the quality of mental healthcare provided to patients with schizophrenic disorders in the Italian region of Lombardy.

Design

Forty-one clinical indicators were applied to Lombardy's healthcare databases containing data on mental health treatments, hospital admissions, somatic health treatments and pharmaceutical prescriptions.

Setting

All public departments of mental health and private residential facilities in Lombardy.

Participants

All 28 227 patients with schizophrenic disorders that were under the care of Lombardy mental health services in 2009.

Interventions

N/A.

Main outcome measures

N/A.

Results

The care that was delivered to patients and family members was more frequent for first-episode cases than for prevalent ones. Seven out of ten patients made use of continuing care and, after hospitalization, more than half of the discharged patients received a follow-up visit by community mental health centre staff within 2 weeks of their discharge. Psychotherapeutic and psychoeducative treatments, such as employment and independent living support, were not widespread among these discharged patients. Antipsychotic drug dosage was usually within the recommended range. The adherence of first-episode patients to antipsychotic treatment was lower than that of prevalent patients, and the monitoring of metabolic side effects was not always consistent. Inappropriateness of hospital care, in terms of longer admission, readmission, compulsory admission and restraint, was limited. Mortality during the period was significant.

Conclusions

Clinical indicators demonstrate the strengths and weaknesses of the mental health system in Lombardy and they can be useful tools in the routine assessment of mental healthcare quality.

Trigger tool versus verbal inventory to detect surgical complications

Purpose

Traditionally, registering complications after surgery is based on voluntary reporting or incident reports. These methods may fail to detect the total number of complications. A trigger tool was developed to detect complications in hospitalized surgical patients. In this diagnostic study, we compared its sensitivity and specificity with the verbal inventory by surgical staff and residents.

Methods

A set of 31 potential triggers was chosen based on a systematic review and availability in hospital databases. The trigger tool was developed using multivariable regression and Receiver Operating Characteristic (ROC) analyses. A reference standard consisted of 300 patients, 150 with and 150 without complications. Sensitivity and specificity of the trigger tool and verbal inventory were determined.

Results

The final trigger tool consisted of nine triggers. Sensitivities of the trigger tool and verbal inventory were 70.7 vs. 78.7 %, respectively, while specificities were 70.0 vs. 100.0 %, respectively. Sensitivity values to detect major complications were 97.2 vs. 80.6 %, respectively.

Conclusions

The proposed customized trigger tool for a university hospital to detect surgical patients with complications appeared as accurate as a verbal inventory and even more accurate to detect major complications.

Managing mass events and competitions with difficult-to-access locations using mobile electrocardiac monitoring

OBJECTIVE

Using mobile wireless technology to monitor ECG in participants of mass events and sports taking place in difficult-to-access location could both prevent and easier detect arrhythmias as well as provide real-time monitoring for any type of injury. We assessed the effectiveness of mobile wireless monitoring technology and IT in detecting possible emergencies during a skyscraper race.

METHODS

We attached specially designed wireless surveillance biopatches on 120 individuals participating to monitor their continuous ECG and location during a skyscraper run-up race at Taipei 101 building, Taiwan. The outcomes of interest were detection of abnormal heartbeats and QRS waves indicative of possible cardiac problems and the exact location of participants during the occurrence of emergencies.

RESULTS

The devices accurately sent over 50 warnings to our monitoring platform when both, danger limits were reached by competitors (<60 or >195 beats per minute) or competitors stopped moving, proving very effective in quickly detecting abnormities and alerting staff of possible emergencies at exact locations.

CONCLUSION

This efficient and inexpensive monitoring method can also prevent arrhythmias in unscreened competitors, the danger of collision among staff and competitors, and preserves oxygen by eliminating additional on-foot monitoring staff. Additionally, it could have multipurpose usage, especially during disasters and accidents occurring in difficult-to-access locations, in military exercises and personal monitoring.