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Rodin NM, Miller JC, Ishibashi T, Powell AJ, McKeirnan KC. Focused Preceptor Feedback Assessing Student Pharmacists' Ability to Administer Pediatric Immunizations. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:101252. [PMID: 39053812 DOI: 10.1016/j.ajpe.2024.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/03/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To evaluate experiential pharmacy preceptor perceptions of student pharmacists' ability to administer pediatric immunizations. METHODS Semi-structured, qualitative key informant interviews using the Outcomes Evaluation Framework were conducted with 10 pharmacist preceptors in outpatient community pharmacies where pediatric immunizations were provided. Interviews were audio-recorded, transcribed, and deidentified prior to analysis by the research team. Qualitative analysis and thematic coding procedures were used to identify relevant themes. RESULTS Saturation was met after 10 pharmacists participated. All stated that it was beneficial for student pharmacists to administer pediatric vaccines if trained in proper technique. Participants acknowledged that the training students currently receive in immunization administration within the PharmD curriculum is valuable but did identify general confidence and child-comforting techniques during and after vaccination as areas of improvement for students. Just-in-time training, preceptor coaching, and hands-on practice outside of the didactic curriculum were utilized to help build confidence. Barriers to the implementation or expansion of pediatric immunization delivered by students in community pharmacies were identified as competing priorities, time, and reimbursement. CONCLUSION Student pharmacists can be helpful in easing the challenges of incorporating pediatric immunization services into the community pharmacy setting. Results demonstrate that the integration of student pharmacists into these services is beneficial. Pediatric immunizations are still relatively new to many pharmacists and specific training for pediatric immunization administration may not be integrated into all Doctor of Pharmacy curricula but the experiential education of pediatric immunization training can be beneficial to help prepare student pharmacists for hands-on practice.
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Affiliation(s)
- Nicole M Rodin
- Washington State University, Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA.
| | - Jennifer C Miller
- Washington State University, Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Tiffany Ishibashi
- Washington State University, Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Alexa J Powell
- Washington State University, Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Kimberly C McKeirnan
- Washington State University, Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
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Rickey L, Auger K, Britto MT, Rodgers I, Field S, Odom A, Lehr M, Cronin A, Walsh KE. Measurement of Ambulatory Medication Errors in Children: A Scoping Review. Pediatrics 2023; 152:e2023061281. [PMID: 37986581 DOI: 10.1542/peds.2023-061281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability. METHODS We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type. RESULTS We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability. CONCLUSIONS Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabelle Rodgers
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Shayna Field
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alayna Odom
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Madison Lehr
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Interventions to Reduce Pediatric Prescribing Errors in Professional Healthcare Settings: A Systematic Review of the Last Decade. Paediatr Drugs 2021; 23:223-240. [PMID: 33959936 DOI: 10.1007/s40272-021-00450-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pediatric medication therapy is prone to errors due to the need for pharmacokinetic and pharmacodynamic individualization and the diverse settings in which pediatric patients are treated. Prescribing errors have been reported as the most common medication error. OBJECTIVES The aim of this review was to systematically identify interventions to reduce prescribing errors and corresponding patient harm in pediatric healthcare settings and to evaluate their impact. METHODS Four databases were systematically screened (time range November 2011 to December 2019), and experimental studies were included. Interventions to reduce prescribing errors were extracted and classified according to a 'hierarchy of controls' model. RESULTS Forty-five studies were included, and 70 individual interventions were identified. A bundle of interventions was more likely to reduce prescribing errors than a single intervention. Interventions classified as 'substitution or engineering controls' were more likely to reduce errors in comparison with 'administrative controls', as is expected from the hierarchy of controls model. Fourteen interventions were classified as substitution or engineering controls, including computerized physician order entry (CPOE) and clinical decision support (CDS) systems. Administrative controls, including education, expert consultations, and guidelines, were more commonly identified than higher level controls, although they may be less likely to reduce errors. Of the administrative controls, expert consultations were most likely to reduce errors. CONCLUSIONS Interventions to reduce pediatric prescribing errors are more likely to be successful when implemented as part of a bundle of interventions. Interventions including CPOE and CDS that substitute risks or provide engineering controls should be prioritized and implemented with appropriate administrative controls including expert consultation.
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Morse-Brady J, Marie Hart A. Prevalence and types of vaccination errors from 2009 to 2018: A systematic review of the medical literature. Vaccine 2020; 38:1623-1629. [PMID: 31862198 DOI: 10.1016/j.vaccine.2019.11.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Vaccination practices and the programmatic factors that influence them are essential for public health. Several barriers impact vaccination efforts, including vaccination errors, which pose the risk of reduced population-wide vaccination efficacy and individual adverse drug events. This study aimed to define the prevalence of vaccination errors documented in English language medical literature between 2009 and 2018 and to identify the common types of errors that occurred during this period. METHODS This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The study protocol was registered with the International Prospective Register of Systematic Reviews prior to research activities. The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, ProQuest Central, PubMed, Scopus, and Web of Science were searched using predetermined search terms. Included data were from primary studies or retrospective analyses that assessed the prevalence and/or type of vaccination errors and that were peer-reviewed, conducted between 2009 and 2018, and published in English. Data were extracted using the Cochrane Data Extraction and Assessment Template and assessed using the Appraisal tool for Cross-Sectional Studies. Pooled vaccination error prevalence was then calculated. RESULTS Of the 1310 independent records that were identified and screened, 17 studies from five countries met all inclusion criteria. Pooled vaccination error prevalence was calculated to be 1.15 per 10,000 vaccine doses (range, 0.005-141.69 per 10,000 doses). The most commonly reported vaccination errors were "wrong vaccine administered" and "off-schedule administration." CONCLUSIONS International rates of vaccination error reporting remain low, with few reports of significant adverse reactions. Vaccination programs should consider the impact of vaccination errors on individual and population health, particularly focusing on the impact of "wrong vaccine" administration. Continued monitoring and promotion of error reporting will enable further understanding of this topic.
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Affiliation(s)
- Jesse Morse-Brady
- University of Wyoming, Fay W. Whitney School of Nursing, Dept. 3065, 1000 E. University Avenue, Laramie, WY 82071, United States.
| | - Ann Marie Hart
- University of Wyoming, Fay W. Whitney School of Nursing, Dept. 3065, 1000 E. University Avenue, Laramie, WY 82071, United States
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Abstract
OBJECTIVE The aim of this study is to review literature about how the pharmacist's role as vaccination providers has been financially and clinically measured. METHODS A broad literature search was conducted up to May 2016 to identify economic or clinical data on pharmacy vaccinations. MEDLINE® and PUBMED databases were searched for publications useful or potentially useful for this review. The NIH and CDC websites were also searched for relevant materials. Search terms included vaccination, pharmacist, economic, pharmacoeconomics, cost, benefits cost-effectiveness, physicians, immunizations, vaccinations, pharmacy vaccines, cost, physician vaccines, financial, benefit, ambulatory pharmacist vaccination, clinical pharmacist, economics, pharmacist vaccine impact. RESULTS The search yielded a total of 68 articles of which 12 met the criteria to be included in this review. After examining articles for relevance to pharmacy vaccinations, two tables were created to highlight the clinical and economic advantages of the pharmacist as a vaccinator. CONCLUSION Pharmacists who administer vaccines are an underutilized provider. This literature review reveals a pattern among studies measuring the pharmacist's impact on vaccination rates, patient preferences, and cost savings. Pharmacists have a history of demonstrated dependability, accuracy, and cost effectiveness. State laws, collaborative agreements, and health plans have continued to prevent patients from using the pharmacy to receive the CDC recommended vaccines. These barriers ultimately delay the Healthy People 2020 goals.
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Brown SW, Oliveri LM, Ohler KH, Briars L. Identification of Errors in Pediatric Prescriptions and Interventions to Prevent Errors: A Survey of Community Pharmacists. J Pediatr Pharmacol Ther 2019; 24:304-311. [PMID: 31337993 DOI: 10.5863/1551-6776-24.4.304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Assess the competency of community pharmacists in identifying errors in pediatric prescriptions and to determine how often pharmacists perform interventions known to mitigate the likelihood of error. The study sought to recognize factors that may impact the pharmacist's ability to identify and mediate these errors, and to detect barriers that limit the role of the pharmacist pediatric patient care. METHODS A survey was distributed through the University of Illinois at Chicago College of Pharmacy Alumni Network and the Illinois Pharmacists Association email listservs. Pharmacists practicing in a retail setting within the last 5 years were included. Three prescription scenarios for commonly used pediatric medications with corresponding questions were created to assess a pharmacist's ability to identify errors. Demographics pertaining to the pharmacist and the practice site, as well as information about dispensing practices, were collected. Logistic regression was used to identify factors that might impact the pharmacists' ability to identify errors. RESULTS One hundred sixty-one respondents began the survey and 138 met inclusion criteria. In 15% to 59% of scenario-based questions, pharmacists did not appropriately identify errors or interventions that would decrease the likelihood of error. Correct identification of doses was associated with total prescription volume in one scenario and with pediatric prescription volume in another scenario. Pharmacists did not consistently label prescriptions for oral liquids in milliliters or dispense oral syringes. Barriers to pharmacist involvement included availability and interest of the caregiver, ability to contact prescriber, and pharmacy staffing. CONCLUSION Community pharmacists did not consistently identify medication errors or use interventions known to mitigate error risk.
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Thompson K, Gammal RS, Benefield EC, Condren ME. Ambulatory Care Training Within Postgraduate Year 2 Pediatric Pharmacy Residency Programs. J Pediatr Pharmacol Ther 2019; 24:214-219. [PMID: 31093020 DOI: 10.5863/1551-6776-24.3.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study evaluates pediatric ambulatory care training opportunities for postgraduate year 2 (PGY2) pediatric pharmacy residents. METHODS An online survey was disseminated to PGY2 pediatric pharmacy residency directors. The questions involved the number and type of pediatric ambulatory care rotations offered; number of preceptors who practice in pediatric ambulatory care; whether or not a pediatric ambulatory care rotation is a requirement of the program; length and format of the rotations; amount of time residents spend in the pediatric ambulatory care setting; and the resident's role during pediatric ambulatory care rotations. RESULTS The survey yielded an 85% response rate (n = 41/48). Most residency programs offer at least 1 pediatric ambulatory care rotation (n = 38; 93%), most of which are longitudinal experiences, and two thirds of programs require their resident(s) to complete a pediatric ambulatory care rotation (n = 27; 66%). These experiences involve a variety of specialty clinics, and residents assume diverse roles and responsibilities. Few programs offer residents the opportunity to practice under a collaborative drug therapy management agreement (n = 6; 15%) or develop new clinical services (n = 6; 15%). Most residency program directors (n = 39; 95%) reported that less than 25% of their residency graduates work in the pediatric ambulatory care setting. CONCLUSIONS Ambulatory care experiences in PGY2 pediatric pharmacy residency programs are diverse in number and scope. There is an opportunity to expand pediatric ambulatory care rotation offerings, particularly with respect to collaborative drug therapy management and the establishment of new clinical services.
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Omecene NE, Patterson JA, Bucheit JD, Anderson AN, Rogers D, Goode JV, Caldas LM. Implementation of pharmacist-administered pediatric vaccines in the United States: major barriers and potential solutions for the outpatient setting. Pharm Pract (Granada) 2019; 17:1581. [PMID: 31275506 PMCID: PMC6594428 DOI: 10.18549/pharmpract.2019.2.1581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nicole E Omecene
- School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Julie A Patterson
- School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - John D Bucheit
- School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Apryl N Anderson
- School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Danielle Rogers
- School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Jean V Goode
- School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Lauren M Caldas
- School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
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Meyers R, Weilnau J, Holmes A, Girotto JE. Position Paper: Pharmacists and Childhood Vaccines. J Pediatr Pharmacol Ther 2018; 23:343-346. [PMID: 30181727 DOI: 10.5863/1551-6776-23.4.343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vaccination rates of children in the United States remain below the target coverage levels identified in the Healthy People 2020 objectives. Given the success of pharmacists in providing adult vaccinations and the accessibility of pharmacists to the public, expanding pharmacists' authority to vaccinate children may improve vaccination rates of children, particularly in key disease states. This article serves as a Position Statement of the Pediatric Pharmacy Advocacy Group (PPAG), who supports the expansion of pharmacists' authority to vaccinate children. PPAG also believes that increased use of state vaccination registries by pharmacists will help improve communication and documentation of vaccines between providers. PPAG also recommends that continued education and maintaining current knowledge of vaccines and vaccine schedules are vital for pharmacist immunizers. Finally, PPAG believes that pharmacists should be advocates for childhood vaccinations.
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Tjon J, Chen L, Pe M, Poh J, Strzelecki M. A Pilot Project for Clinical Pharmacy Services in a Clinic for Children With Medical Complexity. J Pediatr Pharmacol Ther 2017; 22:246-250. [PMID: 28943817 DOI: 10.5863/1551-6776-22.4.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary objective of the project was to assess the impact of clinical pharmacy services in a clinic for children with medical complexity. Secondary objectives were to identify and characterize the drug-related needs of these patients and to describe and develop the role of a pharmacist in the clinic. METHODS This was a prospective descriptive study in which a clinical pharmacist staffed the clinic for children with medical complexity for 11 weeks, from January to March 2011. This allowed for the collection of baseline data, such as patient characteristics and measurements of pharmacist workload and assessment (eg, types of drug therapy problems, medication reconciliation, medication teaching). RESULTS A pharmacist participated in 46 clinic visits with 43 patients, identifying a total of 42 drug therapy problems. Of the 42 problems, 35 actual and 7 potential drug problems were identified, resulting in approximately 1 problem per patient. The most common actual problems included "dose too small" (37.1%) and "patient requires a medication for untreated condition" (20%). Common potential problems included "drug interactions" (43%) and "adverse effects" (57%). CONCLUSIONS The pilot study demonstrates that children with medical complexity are at high risk for drug therapy problems and the presence of a clinic pharmacist is beneficial in the identification, prevention, and resolution of drug therapy problems, while helping ensure continuity of care in this population.
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The impact of pharmacist immunization programs on adult immunization rates: A systematic review and meta-analysis. J Am Pharm Assoc (2003) 2017; 56:418-26. [PMID: 27450138 DOI: 10.1016/j.japh.2016.03.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/11/2016] [Accepted: 03/19/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To estimate the impact that pharmacist immunization programs have on immunization rates. DATA SOURCES Pubmed, Ovid/Medline, and Google Scholar were searched. References were checked and citation searches using identified studies conducted. STUDY SELECTION Studies were eligible for the systematic review and meta-analysis if the study compared pharmacist as immunizer versus usual care. Any study design that involved a comparison group was acceptable. DATA EXTRACTION Data were extracted by 2 investigators independently with the use of a standardized data extraction form; any differences were resolved by consensus. RESULTS A total of 8 studies with 11 study arms met inclusion criteria. A wide variety of immunizations were provided, including influenza, herpes zoster, pneumococcal, Tdap, hepatitis A and B, MMR, varicella, meningococcal, and human papillomavirus. Immunizations were provided in a variety of settings, including hospitals, single community sites, multiple sites, and a university. The overall risk ratio (RR) for immunizations was 2.95 (P <0.001) but varied substantially based on type of vaccine administered (heterogeneity: I(2) = 93.28%). For influenza, the RR was 2.23 (P <0.001), for herpes RR was 4.78 (P <0.001), and for other vaccines RR was 3.44 (P <0.001). The RR for comparisons by type of vaccine and sample size was significant (P = 0.010 and P <0.001, respectively). CONCLUSION Pharmacist immunization programs can have a substantial impact on immunization rates, but the impact varied widely. Widespread implementation of pharmacist immunization programs that include an advocacy component could help in the reaching of Healthy People 2020 immunization goals.
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Wise KA, Sebastian SJ, Haas-Gehres AC, Moore-Clingenpeel MD, Lamberjack KE. Pharmacist impact on pediatric vaccination errors and missed opportunities in the setting of clinical decision support. J Am Pharm Assoc (2003) 2017; 57:356-361. [PMID: 28427898 DOI: 10.1016/j.japh.2017.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine pharmacist impact on vaccination errors and missed opportunities in the pediatric primary care setting with the presence of clinical decision support (CDS) by comparing a clinic with a pharmacist and CDS to a clinic with CDS alone. DESIGN A retrospective chart review of patients' electronic medical records compared vaccination errors and missed opportunities between 2 pediatric primary care clinics. SETTING Two urban, pediatric primary care clinics were selected for the study. PARTICIPANTS Encounters were included in the analysis for children presenting for any visit over a 3-month period. INTERVENTION The intervention clinic had a full-time clinical pharmacist and CDS. The comparison clinic had CDS alone. MAIN OUTCOME MEASURES Vaccination errors were defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended dosing interval, unnecessary doses, and invalid doses for a combination of these reasons. Missed opportunities were defined as vaccine doses due at the date of encounter but not administered, without documented reason for vaccination delay or refusal by provider or patient. The likelihood of missing an opportunity was also assessed for patient age, visit type, and provider type. RESULTS One thousand and twenty patient encounters were randomly selected and reviewed. The vaccination error rate was 0.4% in the comparison group and 0% in the intervention group (P = 0.4995). The number of encounters with a missed opportunity was significantly higher in the comparison group compared with the intervention group (51 vs. 30 encounters with missed opportunities; P = 0.015; adjusted odds ratio, 2.14 [95% CI 1.3-35]). CONCLUSION Although the use of CDS results in a low rate of vaccination errors, technology cannot be solely relied on for vaccination recommendations in the pediatric population because of the rigidity of CDS configuration. Pharmacists continue to play a vital role to ensure that children are appropriately vaccinated in the primary care setting.
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Medication Safety. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Vaccination errors reported to the Vaccine Adverse Event Reporting System, (VAERS) United States, 2000-2013. Vaccine 2015; 33:3171-8. [PMID: 25980429 DOI: 10.1016/j.vaccine.2015.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 11/21/2022]
Abstract
IMPORTANCE Vaccination errors are preventable events. Errors can have impacts including inadequate immunological protection, possible injury, cost, inconvenience, and reduced confidence in the healthcare delivery system. OBJECTIVES To describe vaccination error reports submitted to the Vaccine Adverse Event Reporting System (VAERS) and identify opportunities for prevention. METHODS We conducted descriptive analyses using data from VAERS, the U.S. spontaneous surveillance system for adverse events following immunization. The VAERS database was searched from 2000 through 2013 for U.S. reports describing vaccination errors and reports were categorized into 11 error groups. We analyzed numbers and types of vaccination error reports, vaccines involved, reporting trends over time, and descriptions of errors for selected reports. RESULTS We identified 20,585 vaccination error reports documenting 21,843 errors. Annual reports increased from 10 in 2000 to 4324 in 2013. The most common error group was "Inappropriate Schedule" (5947; 27%); human papillomavirus (quadrivalent) (1516) and rotavirus (880) vaccines were most frequently involved. "Storage and Dispensing" errors (4983; 23%) included mostly expired vaccine administered (2746) and incorrect storage of vaccine (2202). "Wrong Vaccine Administered" errors (3372; 15%) included mix-ups between vaccines with similar antigens such as varicella/herpes zoster (shingles), DTaP/Tdap, and pneumococcal conjugate/polysaccharide. For error reports with an adverse health event (5204; 25% of total), 92% were classified as non-serious. We also identified 936 vaccination error clusters (i.e., same error, multiple patients, in a common setting) involving over 6141 patients. The most common error in clusters was incorrect storage of vaccine (582 clusters and more than 1715 patients). CONCLUSIONS Vaccination error reports to VAERS have increased substantially. Contributing factors might include changes in reporting practices, increasing complexity of the immunization schedule, availability of products with similar sounding names or acronyms, and increased attention to storage and temperature lapses. Prevention strategies should be considered.
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