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Toni E, Ayatollahi H, Abbaszadeh R, Fotuhi Siahpirani A. Risk Factors Associated With Drug-Related Side Effects in Children: A Scoping Review. Glob Pediatr Health 2024; 11:2333794X241273171. [PMID: 39205860 PMCID: PMC11350535 DOI: 10.1177/2333794x241273171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/22/2024] [Accepted: 07/05/2024] [Indexed: 09/04/2024] Open
Abstract
Objective. Children's vulnerability to drug-related side effects has been highlighted in several studies. However, there is no consensus on the risk factors associated with these side effects. This study aimed to investigate risk factors associated with drug-related side effects in children. Methods. This scoping review was conducted across multiple databases. The search strategy was created with a focus on drug-related side effects, as they are more predictable based on the pre-determined risk factors. Data were collected, and reported narratively. Results. The demographic, health, hospital, and drug-related risk factors may cause drug-related side effects in children. Among them, low age, sex, polypharmacy, length of hospitalization, and medications used for comorbidities may increase the risk. Conclusion. While most of the risk factors might be similar in adults and children, their impact might be different in these 2 groups. Therefore, future studies should identify more details about the impact of the risk factors in children.
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Affiliation(s)
- Esmaeel Toni
- Iran University of Medical Sciences, Tehran, Iran
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Alcântara TDS, Carvalho GAC, Sanchez JM, Ramos SF, Cunha LC, Araújo-Neto FDC, Valença-Feitosa F, Silvestre CC, Lyra Junior DPD. Quality indicators of hospitalized children influenced by clinical pharmacist services: A systematic review. Res Social Adm Pharm 2023; 19:1315-1330. [PMID: 37442709 DOI: 10.1016/j.sapharm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/31/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. OBJECTIVE To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. METHODS A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. RESULTS The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. CONCLUSION In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs.
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Affiliation(s)
- Thaciana Dos Santos Alcântara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Júlia Mirão Sanchez
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Luiza Correia Cunha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernando de Castro Araújo-Neto
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernanda Valença-Feitosa
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Carina Carvalho Silvestre
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil.
| | - Divaldo Pereira de Lyra Junior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Implementation and Routinization of the ABCDE Bundle: A Mixed Methods Evaluation. Dimens Crit Care Nurs 2021; 40:333-344. [PMID: 34606224 DOI: 10.1097/dcc.0000000000000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The ABCDE (Awakening and Breathing Coordination, Delirium monitoring and management, and Early exercise/mobility) bundle has been associated with reductions in delirium incidence and improved patient outcomes but has not been widely adopted. OBJECTIVE The objective of this study was to determine how to facilitate ABCDE bundle adoption by examining the impact of different implementation strategies on bundle adherence rates and assessing clinicians' perceptions of the bundle and implementation efforts. METHODS This study examined the effect of 2 bundle implementation strategies on patient care in 8 adult intensive care units. The basic strategy included electronic health record (EHR) modification, whereas the enhanced strategy included EHR modification plus additional bundle training, clinical champions, and staff engagement. A total of 84 nurses, physicians, and therapists participated in interviews and a survey to assess bundle implementation. RESULTS Respondents indicated bundle use resulted in "best care" through care standardization and coordination and improved patient outcomes. Intensive care units in both intervention groups had significant improvements in bundle adherence after implementation efforts, but intensive care units in the basic intervention group outperformed other sites after initiating their own implementation strategies. Successful implementation tactics included incorporating the bundle into multidisciplinary rounds and providing ongoing support, training, and routine auditing and feedback. DISCUSSION The ABCDE bundle can improve quality of care and outcomes, and implementation can be accelerated through EHR tools, trainings, and performance feedback.
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Lyren A, Brilli R, Bird M, Lashutka N, Muething S. Ohio Children's Hospitals' Solutions for Patient Safety: A Framework for Pediatric Patient Safety Improvement. J Healthc Qual 2018; 38:213-22. [PMID: 26042749 DOI: 10.1111/jhq.12058] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Building upon their previous collective success and a clinical imperative for rapid improvement, the eight tertiary pediatric referral centers in Ohio sought to dramatically decrease the most serious types of harm that occur to hospitalized children by collectively employing high reliability methods focused on safety culture. METHODS With the support of the hospitals' executives, the Ohio collaborative obtained legal protection and built will by clearly identifying types and frequency of harm events that occur in each participating hospital and across the state. The improvement efforts were divided among task forces designed to incorporate the principles of high reliability organizations into the work of all employees, focusing primarily on the consistent application of error prevention behaviors. RESULTS Between January 2010 and October 2012, the serious safety event rate among the participating hospitals decreased by 55%, equating to 70 fewer children per year who experienced this most severe type of event in the participating hospitals. Between January 2011 and October 2012, all events of serious harm were decreased by 40%, meaning 18 fewer children per month suffered serious harm. CONCLUSION Rapid and significant improvement in pediatric patient safety is possible through collaboration of children's hospitals dedicated to the application of high reliability principles and the noncompetitive sharing of outcomes and best practices.
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Park MS. Quality improvement in pediatric care. KOREAN JOURNAL OF PEDIATRICS 2018; 61:1-5. [PMID: 29441105 PMCID: PMC5807984 DOI: 10.3345/kjp.2018.61.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 11/27/2022]
Abstract
We often overlook the importance of several safety issues such as identification of patients, timeout procedure, hand hygiene, handoff communication, and many others. This ignorance, along with many other issues, leads to medical error being ranked as a third leading cause of death in the U.S. Consequently, quality improvement (QI) has become one of the major subjects in healthcare despite a relatively short history. Improving quality is about making healthcare safe, effective, patient-centered, timely, efficient, and equitable. Understanding the need and methodology of QI as well as participation is now essential for physicians. Although basic QI methodology has not changed, one of the most fascinating changes in recent QI is conducting large-scale QI projects through multicenter networks. Prospective multicenter QI projects utilizing the Korean Neonatal Network are a substantial initiation of pediatric QI in Korea. The Korean Pediatric Society should set ambitious goals for QI activities for every primary care pediatrician and pediatric subspecialist.
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Affiliation(s)
- Moon Sung Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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Schwartz SP, Rehder KJ. Quality improvement in pediatrics: past, present, and future. Pediatr Res 2017; 81:156-161. [PMID: 27673419 DOI: 10.1038/pr.2016.192] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/24/2016] [Indexed: 11/09/2022]
Abstract
Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.
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Affiliation(s)
- Stephanie P Schwartz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina
| | - Kyle J Rehder
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.,Physician Quality Officer, Patient Safety Center, Duke University Health System, Durham, North Carolina
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Alvarez F, Ismail L, Markowsky A. Pediatric Medication Safety in Adult Community Hospital Settings: A Glimpse Into Nationwide Practice. Hosp Pediatr 2016; 6:744-749. [PMID: 27811162 DOI: 10.1542/hpeds.2016-0068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Most children in the United States are treated in adult settings. Studies show that the pediatric population is vulnerable to medication errors. It can be extrapolated that children cared for in adult settings are at equal or higher risk for errors. The goal of this study was to assess the existing pediatric medication safety infrastructure within adult hospitals. METHODS Questionnaire developed through Research Electronic Data Capture (REDCap) and distributed to pediatric hospitalist programs listed on the American Academy of Pediatrics, Section on Hospital Medicine web site and members of the American Academy of Pediatrics Quality Improvement Innovation Networks listserv. There were >20 questions regarding the use of various safety measures and characteristics of the hospital. RESULTS Thirty-eight program staff and 26 Quality Improvement Innovation Networks listserv members completed the survey (total = 64). Of these, 90.6% use order sets or computerized provider order entry with pediatric weight-based dosing, 79.7% review pediatric medication safety events or concerns, 58.7% were aware that their hospital had defined or documented maximum doses on orders, and 50.0% had milligram-per-kilogram dosing required to be in the order. A majority of respondents document weights only in the metric system (kilograms or grams) in both the emergency department and the pediatric unit (84.4% and 92.1%, respectively). A total of 57.8% of hospitals had pharmacists trained in pediatrics, with hospitals with >300 beds more likely to have a pediatric pharmacist than those with <300 beds (75% vs 44%, P ≤ .05). CONCLUSIONS Pediatric medication safety infrastructure shows variations within the sites surveyed. Our results indicate that certain deficiencies are more widespread than others, providing opportunities for targeted, but hospital-specific interventions.
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Affiliation(s)
- Francisco Alvarez
- Division of Hospitalist Medicine, Children's National Medical Center, Washington, District of Columbia;
- George Washington University School of Medicine, Washington, District of Columbia; and
- Mary Washington Hospital, Fredericksburg, Virginia
| | - Lana Ismail
- Division of Hospitalist Medicine, Children's National Medical Center, Washington, District of Columbia
- George Washington University School of Medicine, Washington, District of Columbia; and
- Mary Washington Hospital, Fredericksburg, Virginia
| | - Allison Markowsky
- Division of Hospitalist Medicine, Children's National Medical Center, Washington, District of Columbia
- George Washington University School of Medicine, Washington, District of Columbia; and
- Mary Washington Hospital, Fredericksburg, Virginia
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Affiliation(s)
- Umo I. Esen
- Department of Obstetrics & Gynaecology, South Tyneside NHS Foundation Trust, Harton Lane, South Shields, Tyne and Wear, UK
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Ford JH, Robinson JM, Wise ME. Adaptation of the Grasha Riechman Student Learning Style Survey and Teaching Style Inventory to assess individual teaching and learning styles in a quality improvement collaborative. BMC MEDICAL EDUCATION 2016; 16:252. [PMID: 27681711 PMCID: PMC5041280 DOI: 10.1186/s12909-016-0772-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/20/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND NIATx200, a quality improvement collaborative, involved 201 substance abuse clinics. Each clinic was randomized to one of four implementation strategies: (a) interest circle calls, (b) learning sessions, (c) coach only or (d) a combination of all three. Each strategy was led by NIATx200 coaches who provided direct coaching or facilitated the interest circle and learning session interventions. METHODS Eligibility was limited to NIATx200 coaches (N = 18), and the executive sponsor/change leader of participating clinics (N = 389). Participants were invited to complete a modified Grasha Riechmann Student Learning Style Survey and Teaching Style Inventory. Principal components analysis determined participants' preferred learning and teaching styles. RESULTS Responses were received from 17 (94.4 %) of the coaches. Seventy-two individuals were excluded from the initial sample of change leaders and executive sponsors (N = 389). Responses were received from 80 persons (25.2 %) of the contactable individuals. Six learning profiles for the executive sponsors and change leaders were identified: Collaborative/Competitive (N = 28, 36.4 %); Collaborative/Participatory (N = 19, 24.7 %); Collaborative only (N = 17, 22.1 %); Collaborative/Dependent (N = 6, 7.8 %); Independent (N = 3, 5.2 %); and Avoidant/Dependent (N = 3, 3.9 %). NIATx200 coaches relied primarily on one of four coaching profiles: Facilitator (N = 7, 41.2 %), Facilitator/Delegator (N = 6, 35.3 %), Facilitator/Personal Model (N = 3, 17.6 %) and Delegator (N = 1, 5.9 %). Coaches also supported their primary coaching profiles with one of eight different secondary coaching profiles. CONCLUSIONS The study is one of the first to assess teaching and learning styles within a QIC. Results indicate that individual learners (change leaders and executive sponsors) and coaches utilize multiple approaches in the teaching and practice-based learning of quality improvement (QI) processes. Identification teaching profiles could be used to tailor the collaborative structure and content delivery. Efforts to accommodate learning styles would facilitate knowledge acquisition enhancing the effectiveness of a QI collaborative to improve organizational processes and outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00934141 Registered July 6, 2009. Retrospectively registered.
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Affiliation(s)
- James H. Ford
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726 USA
| | - James M. Robinson
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI 53726 USA
| | - Meg E. Wise
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705 USA
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Wu S, Tyler A, Logsdon T, Holmes NM, Balkian A, Brittan M, Hoover L, Martin S, Paradis M, Sparr-Perkins R, Stanley T, Weber R, Saysana M. A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children. Pediatrics 2016; 138:peds.2014-3604. [PMID: 27464675 DOI: 10.1542/peds.2014-3604] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. METHODS This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. RESULTS Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). CONCLUSIONS Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings.
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Affiliation(s)
- Susan Wu
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California;
| | - Amy Tyler
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Tina Logsdon
- Children's Hospital Association, Overland Park, Kansas
| | - Nicholas M Holmes
- Department of Surgery, Division of Urology, University of California San Diego, San Diego, California; Rady Children's Hospital San Diego, San Diego, California
| | - Ara Balkian
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California
| | - Mark Brittan
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - LaVonda Hoover
- Children's Hospital Los Angeles, Los Angeles, California
| | - Sara Martin
- Children's Hospital Colorado, Aurora, Colorado
| | | | | | - Teresa Stanley
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana; and
| | - Rachel Weber
- Rady Children's Hospital San Diego, San Diego, California
| | - Michele Saysana
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana; and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Poppy A, Retamal-Munoz C, Cree-Green M, Wood C, Davis S, Clements SA, Majidi S, Steck AK, Alonso GT, Chambers C, Rewers A. Reduction of Insulin Related Preventable Severe Hypoglycemic Events in Hospitalized Children. Pediatrics 2016; 138:peds.2015-1404. [PMID: 27317577 PMCID: PMC5901907 DOI: 10.1542/peds.2015-1404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Insulin is a commonly used, high-risk medication in the inpatient setting. Incorrect insulin administration can lead to preventable hypoglycemic events, which are a significant morbidity in inpatient diabetes care. The goal of this intervention was to decrease preventable insulin-related hypoglycemic events in an inpatient setting in a tertiary care pediatric hospital. METHODS Methods included the institution of several interventions such as nursing and physician education, electronic medical record order sets, electronic communication note templates, and the development of new care guidelines. RESULTS After the institution of multiple interventions, the rate of preventable hypoglycemic events decreased from 1.4 preventable events per 100 insulin days to 0.4 preventable events per 100 insulin days. CONCLUSIONS Through the use of a multi-interventional approach with oversight of a multidisciplinary insulin safety committee, a sustained decreased rate of severe preventable hypoglycemic events in hospitalized pediatric patients receiving insulin was achieved.
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Affiliation(s)
- Amy Poppy
- Quality and Patient Safety, Children's Hospital Colorado, Aurora, Colorado;
| | | | - Melanie Cree-Green
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and
| | - Colleen Wood
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and
| | - Shanlee Davis
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and
| | - Scott A. Clements
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and,Division of Endocrinology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Shideh Majidi
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and
| | - Andrea K. Steck
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and
| | - G. Todd Alonso
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and
| | - Christina Chambers
- Division of Endocrinology,,Barbara Davis Center for Childhood Diabetes, and
| | - Arleta Rewers
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz, Aurora, Colorado; and
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McClead RE, Catt C, Davis JT, Morvay S, Merandi J, Lewe D, Stewart B, Brilli RJ. An internal quality improvement collaborative significantly reduces hospital-wide medication error related adverse drug events. J Pediatr 2014; 165:1222-1229.e1. [PMID: 25304926 DOI: 10.1016/j.jpeds.2014.08.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 07/14/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To reduce the rate of harmful adverse drug events (ADEs) of severity level D-I from a baseline peak of 0.24 ADE/1000 doses to 0.08 ADE/1000 doses. STUDY DESIGN A hospital-wide, quasi-experimental time series quality improvement (QI) initiative to reduce ADEs was implemented. High-reliability concepts, microsystem-based multidisciplinary teams, and QI science methods were used. ADEs were detected through a combination of voluntary reporting, trigger tool analysis, reversal agent review, and pharmacy interventions. A multidisciplinary ADE Quality Collaborative focused on medication use processes, not on specific classes of medications. Effective interventions included huddles and an ADE prevention bundle. RESULTS The rate of harmful ADEs initially increased by >65% because of increased error reporting, temporally associated with the implementation of a program focused on high reliability and an improved safety culture. The quarterly rate was 0.17 ADE/1000 dispensed doses in Q1 2010. By the end of Q2 2013, the rate had decreased by 76.5%, to 0.04 ADE/1000 dispensed doses (P < .001). CONCLUSION Using an internal collaborative model and QI methodologies focused on medication use processes, harmful ADEs were reduced hospital-wide by 76.5%. The concurrent implementation of a high-reliability, safety-focused program was important as well.
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Affiliation(s)
- Richard E McClead
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Division of Neonatology, The Ohio State University, Columbus, OH.
| | | | | | | | | | - Dorcas Lewe
- Nationwide Children's Hospital, Columbus, OH
| | | | - Richard J Brilli
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Division of Critical Care Medicine, The Ohio State University, Columbus, OH
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Lee J, Han H, Ock M, Lee SI, Lee S, Jo MW. Impact of a clinical decision support system for high-alert medications on the prevention of prescription errors. Int J Med Inform 2014; 83:929-40. [DOI: 10.1016/j.ijmedinf.2014.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 11/26/2022]
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Stacey S, Coombes I, Wainwright C, Klee B, Miller H, Whitfield K. Characteristics of adverse medication events in a children's hospital. J Paediatr Child Health 2014; 50:966-71. [PMID: 25049060 DOI: 10.1111/jpc.12684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare adverse medication events (AMEs) reported in children, via the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) coding with events reported via other data sources. METHOD AME reports were retrieved using codes Y40-Y59 and X40-X44 over 6 months. Patients' charts were manually reviewed to identify events associated with error and/or harm with medicines during a hospital admission. Medication name, group, error, harm and alert documentation were recorded. Clinical incidents and pharmacist interventions were reviewed for the same period. RESULTS Two hundred sixty-three events from January to June 2011 were recorded by ICD-10 coding in 180 patients. After duplicated, missing or unrelated events were excluded and 146 AMEs remained. In the same period, 117 AMEs were reported as incidents and 190 as pharmacist interventions. In total, 276 children with 447 events were reported via all sources. Little duplication between data sources was evident. In total, 158 events involved harm, with 135 of these from ICD-10 coding, 16 from incident reports and 2 pharmacist interventions (including 6 events from multiple sources). Error was involved in 3% of ICD10 reports, 97% of incidents and 100% of interventions. Only 14% of harm-related events from ICD-10 were documented on the medical record clinical alert. Chemotherapy accounted for 31% of harm-related events, antimicrobials 18%, corticosteroids 14% and narcotics 12%. CONCLUSION Of the harm-related events, 85% were documented via ICD-10 coding with few documented in other databases. Review of ICD-10-coded AMEs can provide valuable information to improve patient safety and quality.
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Affiliation(s)
- Sonya Stacey
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia; Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Bigham MT, Logsdon TR, Manicone PE, Landrigan CP, Hayes LW, Randall KH, Grover P, Collins SB, Ramirez DE, O'Guin CD, Williams CI, Warnick RJ, Sharek PJ. Decreasing handoff-related care failures in children's hospitals. Pediatrics 2014; 134:e572-9. [PMID: 25002665 DOI: 10.1542/peds.2013-1844] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures. METHODS Twenty-three children's hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. RESULTS Twenty-three children's hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P < .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P < .05]; clear transition of responsibility from 92% to 96% [P < .05]; and minimized interruptions and distractions from 84% to 90% [P < .05]) as did overall satisfaction with the handoff (from 55% to 70% [P < .05]). CONCLUSIONS Implementation of a standardized evidence-based handoff process across 23 children's hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction.
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Affiliation(s)
| | | | | | - Christopher P Landrigan
- Department of Medicine, General Pediatrics, Children's Hospital Boston, Boston, Massachusetts
| | | | - Kelly H Randall
- Performance Improvement, Children's of Alabama, Birmingham, Alabama
| | - Purva Grover
- Emergency Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Susan B Collins
- All Children's Hospital, Heart Center, St Petersburg, Florida
| | - Dana E Ramirez
- Department of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia
| | | | - Catherine I Williams
- Patient Care Services, Children's National Medical Center, Washington, District of Columbia
| | | | - Paul J Sharek
- Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, andDivision of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Lista modelo de medicamentos de alto riesgo. An Pediatr (Barc) 2013; 79:360-6. [DOI: 10.1016/j.anpedi.2013.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 11/17/2022] Open
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Maaskant JM, Eskes A, van Rijn-Bikker P, Bosman D, van Aalderen W, Vermeulen H. High-alert medications for pediatric patients: an international modified Delphi study. Expert Opin Drug Saf 2013; 12:805-14. [PMID: 23931332 DOI: 10.1517/14740338.2013.825247] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The available knowledge about high-alert medications for children is limited. Because children are particularly vulnerable to medication errors, a list of high-alert medication specifically for children would help to develop effective strategies to prevent patient harm. Therefore, we conducted an international modified Delphi study and validated the results with reports on medication incidents in children based on national data. OBJECTIVE The objective of this study was to generate an internationally accepted list of high-alert medications for a pediatric inpatient population from birth to 18-years old. RESULTS The rating panel consisted of 34 experts from 13 countries. In total, 14 medications and 4 medication classes were included with the predefined level of consensus of 75%. The high-alert medications were: amiodarone, digoxin, dopamine, epinephrine, fentanyl, gentamycin, heparine, insulin, morphine, norepinephrine, phenytoin, potassium, propofol and tacrolimus. The high-alert medication classes included in the final list were: chemotherapeutic drugs, immunosuppressive medications, lipid/total parenteral nutrition and opioids. CONCLUSION An international group of experts defined 14 medications and 4 medication classes as high-alert for children. This list might be helpful as a starting point for individual hospitals to develop their own high-alert list tailored to their unique situation.
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Affiliation(s)
- Jolanda M Maaskant
- Emma Children's Hospital, Academic Medical Center , PO Box 22660, 1100 DE Amsterdam , the Netherlands +31205668173 ; +31206917735 ;
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Khoo AL, Teng M, Lim BP, Tai HY, Lau TC. A multicenter, multidisciplinary, high-alert medication collaborative to improve patient safety: the Singapore experience. Jt Comm J Qual Patient Saf 2013; 39:205-12. [PMID: 23745479 DOI: 10.1016/s1553-7250(13)39027-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND High-alert medications can cause significant patient harm when used in error. A multicenter, multidisciplinary, high-alert medication collaborative was established in Singapore in 2009 to identify and maintain a current list of high-alert medications and to create systematic approaches for preventing and reducing the risk of medication errors and adverse drug events (ADEs) for high-alert medications. METHODS The collaborative was led by a core multidisciplinary team consisting of pharmacists, nurses, and physicians, as well as clinical services and quality personnel, from six primary and acute care institutions. Multidisciplinary work groups were formed to drive the improvement efforts using the Plan-Do-Study-Act (PDSA) cycles. Tracking of improvement work was conducted with an adaptation of the Institute for Healthcare Improvement Trigger Tool method. RESULTS A localized high-alert medication list was developed through local ADE reports, literature review, an online survey of health care professionals, and expert opinion. Some 130 interventions were proposed to prevent, detect, and mitigate harm from the use of high-alert medications for 10 drug classes/drugs. A significant number of these interventions were tested and revised during the PDSA cycles before implementation throughout the institution and subsequent spread to other institutions. Outcome audits identified areas for improvement. The interventions, which were subsequently incorporated into the change packages, led to a 50% and 67% decline in the ADE rates for radiocontrast agents and heparin, respectively. CONCLUSION The collaborative has provided a sound framework for ongoing development and refinement of high-alert medication change packages and for sharing of ADE data and best practices across the participating institutions.
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Affiliation(s)
- Ai Leng Khoo
- Pharmacy and Therapeutics Office, National Healthcare Group, Singapore.
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