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Beteta Fernández D, Seva Llor AM, Martínez Alarcón L, Pérez Cánovas C, Pardo Ríos M, Alcaraz Martínez J. Health care safety incidents in paediatric emergency care. An Pediatr (Barc) 2024; 101:14-20. [PMID: 38955612 DOI: 10.1016/j.anpede.2024.06.006] [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: 01/05/2024] [Accepted: 04/24/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To characterize safety incidents in paediatric emergency departments (PEDs): frequency, sources, root causes, and consequences. MATERIALS AND METHODS We conducted a cross-sectional, observational and descriptive study in the PED of the Clinical University Hospital XX (blinded for review). Patients were recruited through opportunity sampling and the data were collected during care delivery and one week later through a telephone survey. The methodology was based on the ERIDA study on patient safety incidents related to emergency care, which in turn was based on the ENEAS and EVADUR studies. RESULTS The study included a total of 204 cases. At least one incident was detected in 25 cases, with two incidents detected in 3 cases, for a total incidence of 12.3%. Twelve incidents were detected during care delivery and the rest during the telephone call. Ten percent did not reach the patient, 7.1% reached the patient but caused no harm, and 82.1% reached the patient and caused harm. Thirteen incidents (46.4%) did not have an impact on care delivery, 8 (28.6%) required a new visit or referral, 6 (21.4%) required additional observation and 1 (3.6%) medical or surgical treatment. The most frequent root causes were health care delivery and medication. Incidents related to procedures and medication were most frequent. Of all incidents, 78.6% were considered preventable, with 50% identified as clear failures in health care delivery. CONCLUSIONS Safety incidents affected 12.3% of children managed in the PED of the HCUVA, of which 78.6% were preventable.
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Affiliation(s)
| | | | | | | | - Manuel Pardo Ríos
- UCAM - Universidad Católica de Murcia, Murcia, Spain; Gerencia de Urgencias y Emergencias Sanitarias 061 de la Región de Murcia, Murcia, Spain
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Sakuma M, Ohta Y, Takeuchi J, Yuza Y, Ida H, Bates DW, Morimoto T. Adverse Events in Pediatric Inpatients: The Japan Adverse Event Study. J Patient Saf 2024; 20:38-44. [PMID: 37922224 DOI: 10.1097/pts.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
OBJECTIVES Adverse events (AEs) represent an important cause of morbidity and mortality for pediatric inpatients; however, reports on their epidemiology in pediatrics, especially outside Western countries, are scarce. We investigated the incidence and nature of AEs in pediatric inpatients in Japan. METHODS Trained pediatrician and pediatric nurses reviewed all medical documents of 1126 pediatric inpatients in 2 tertiary care teaching hospitals in Japan, and potential incidents were collected with patients' characteristics. Age was categorized into 6 groups (neonates, infants, preschoolers, school-aged children, teenagers, and over-aged pediatric patients), and medical care when potential incidents occurred was classified into drug, operation, procedure/examinations, nursing, management, and judgment. Physician reviewers independently evaluated all collected incidents into AEs, potential AEs, medical errors, and exclusions and assessed their severity and preventability. RESULTS A total of 1126 patients with 12,624 patient-days were enrolled, and 953 AEs, with an incidence of 76 (95% confidence interval, 71-80) per 1000 patient-days, were identified. Preventable AEs accounted for 23% (218/953) of AEs. The incidence of AEs tended to decrease with increasing age. The proportion of AEs that were preventable was highest in neonates (40%), and this proportion decreased as children aged. Both judgment and management-related AEs were considered preventable AEs, and judgment-related AEs were more severe AEs than no-judgment-related AEs; 43% were life-threatening. CONCLUSIONS Adverse events were common in Japanese pediatric inpatients, and their preventability and severity varied considerably by age category and medical care. Further investigation is needed to address which strategies might most improve pediatric patient safety.
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Affiliation(s)
- Mio Sakuma
- From the Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya
| | - Yoshinori Ohta
- Community Emergency Medicine, Hyogo Medical University, Sasayama
| | - Jiro Takeuchi
- From the Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya
| | | | - Hiroyuki Ida
- The Jikei University School of Medicine, Tokyo, Japan
| | | | - Takeshi Morimoto
- From the Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya
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3
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Alshuhri MS, Alkhateeb BA, Alomair OI, Alghamdi SA, Madkhali YA, Altamimi AM, Alashban YI, Alotaibi MM. Provision of Safe Anesthesia in Magnetic Resonance Environments: Degree of Compliance with International Guidelines in Saudi Arabia. Healthcare (Basel) 2023; 11:2508. [PMID: 37761705 PMCID: PMC10530828 DOI: 10.3390/healthcare11182508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The lack of local guidelines and regulations for the administration of anesthesia in magnetic resonance imaging (MRI) units presents a potential risk to patient safety in Saudi Arabia. Hence, this study aimed to evaluate the extent to which hospitals in Saudi Arabia follow international guidelines and recommendations for the safe and effective administration of anesthesia in an MRI environment. METHODS This study used a questionnaire that was distributed to 31 medical facilities in Saudi Arabia that provided anesthesia in MRI units. RESULTS The findings of the study revealed that the mean compliance with the 17 guidelines across the 31 sites was 77%; 5 of the 31 sites (16.1%) had a compliance rate of less than 50% with the recommended guidelines. Only 19.4% of the institutes provided general safety education. Communication breakdowns between anesthesia providers and MRI teams were reported. CONCLUSIONS To conclude, this survey highlights the status of anesthesia standards in Saudi Arabian MRI units and emphasizes areas that require better adherence to international guidelines. The results call for targeted interventions, including the formulation of specific national anesthesia guidelines for MRI settings. Communication breakdowns between anesthesia providers and MRI teams were reported at a rate of 83.9% during the administration of a gadolinium contrast agent. There were additional breakdowns, particularly for high-risk patients with implants, such as impaired respirators (74.2%), thus requiring further investigation due to potential safety incidents during MRI procedures. While considering the limitations of this study, such as potential biases and the low response rate, it provides a valuable foundation for refining protocols and promoting standardized practices in Saudi Arabian healthcare.
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Affiliation(s)
- Mohammed S. Alshuhri
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O. Box 422, Alkharj 11942, Saudi Arabia;
| | - Bader A. Alkhateeb
- Radiology Department, King Salman Hospital, Cluster One Riyadh, Ministry of Health (MOH), Riyadh 12769, Saudi Arabia;
| | - Othman I. Alomair
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia; (S.A.A.); (Y.I.A.); (M.M.A.)
| | - Sami A. Alghamdi
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia; (S.A.A.); (Y.I.A.); (M.M.A.)
| | - Yahia A. Madkhali
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
| | | | - Yazeed I. Alashban
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia; (S.A.A.); (Y.I.A.); (M.M.A.)
| | - Meshal M. Alotaibi
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia; (S.A.A.); (Y.I.A.); (M.M.A.)
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Lietz A, Kraller J, Hoffelner A, Ritschl V, Berger A, Wagner M. Dose-response of virtual reality training of paediatric emergencies in a randomised simulation-based setting. Acta Paediatr 2023; 112:1995-2005. [PMID: 37195147 DOI: 10.1111/apa.16847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
AIM To determine the effect of different virtual reality training intervals on individual performance to facilitate the optimal implementation of medical virtual reality training. METHODS Emergency scenarios in virtual reality were performed by 36 medical students from the Medical University of Vienna. After baseline training, the participants were randomised into three groups of equal size and underwent virtual reality training at different time intervals (monthly, one training after 3 months, and no further training) before undergoing final assessment training after 6 months. RESULTS Group A, with monthly training exercises, improved their performance score significantly by 1.75 mean score points compared with Group B, who repeated baseline training after 3 months. Statistically significant difference was indicated when comparing Group A with Group C, which was not further trained and served as the control group. CONCLUSION One-month intervals are associated with statistically significant performance improvements compared with additional training after 3 months and to a control group without regular training. The results show that training intervals of 3 months or longer are insufficient to achieve high performance scores. Virtual reality training is a cost-effective alternative to conventional simulation-based training for regular practice.
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Affiliation(s)
- Andrea Lietz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Julian Kraller
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Alexander Hoffelner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
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Halvorson EE, Thurtle DP, Easter A, Lovato J, Stockwell D. Disparities in Adverse Event Reporting for Hospitalized Children. J Patient Saf 2022; 18:e928-e933. [PMID: 35797590 PMCID: PMC9391261 DOI: 10.1097/pts.0000000000001049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hospitals rely on voluntary event reporting (VER) for adverse event (AE) identification, although it captures fewer events than a trigger tool, such as Global Assessment of Pediatric Patient Safety (GAPPS). Medical providers exhibit bias based on patient weight status, race, and English proficiency. We compared the AE rate identified by VER with that identified using the GAPPS between hospitalized children by weight category, race, and English proficiency. METHODS We identified a cohort of patients 2 years to younger than 18 years consecutively discharged from an academic children's hospital between June and October 2018. We collected data on patient weight status from age, sex, height, and weight, race/ethnicity by self-report, and limited English proficiency by record of interpreter use. We reviewed each chart with the GAPPS to identify AEs and reviewed VER entries for each encounter. We calculated an AE rate per 1000 patient-days using each method and compared these using analysis of variance. RESULTS We reviewed 834 encounters in 680 subjects; 262 (38.5%) had overweight or obesity, 144 (21.2%) identified as Black, and 112 (16.5%) identified as Hispanic; 82 (9.8%) of encounters involved an interpreter. We identified 288 total AEs, 270 (93.8%) by the GAPPS and 18 (6.3%) by VER. A disparity in AE reporting was found for children with limited English proficiency, with fewer AEs by VER ( P = 0.03) compared with no difference in AEs by GAPPS. No disparities were found by weight category or race. CONCLUSIONS Voluntary event reporting may systematically underreport AEs in hospitalized children with limited English proficiency.
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Affiliation(s)
- Elizabeth Eby Halvorson
- From the Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Ashley Easter
- From the Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - James Lovato
- Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David Stockwell
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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6
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Bosson N, Kaji AH, Gausche-Hill M. A Standardized Formulary to Reduce Pediatric Medication Dosing Errors: A Mixed Methods Study. PREHOSP EMERG CARE 2021; 26:492-502. [PMID: 34255605 DOI: 10.1080/10903127.2021.1955058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: We hypothesized that implementation of a Medical Control Guideline (MCG) with a standardized formulary (fixed medication concentrations) and pre-calculated medication dosages in a large emergency medical services (EMS) system would reduce pediatric dosing errors. To assess the effectiveness of the standardized formulary to reduce errors, we chose to evaluate midazolam administration for seizures, because it is the most frequently dosed medication by EMS for children, and seizures are a time-sensitive condition. The objective of this study was to compare: 1) frequency of midazolam dosing errors during the field treatment of pediatric seizures and 2) paramedic anxiety and confidence in dosing midazolam for pediatric seizures, before and after implementation of the MCG.Methods: In this mixed-methods study, we utilized the Los Angeles County EMS data registry to identify pediatric patients ≤14 years-old treated with midazolam for seizure. We defined a dosing error as outside the dose directed by the color code on the length-based resuscitation tape, or ±20% the weight-based midazolam dose when color code was absent. We compared dosing errors during a two-year period before and after implementation of the MCG with the standardized formulary in February 2017. We surveyed paramedics to assess their level of anxiety and confidence in dosing midazolam and conducted semi-structured interviews with 20 respondents to further explore its impact on paramedic practice.Results: There were 80 dosing errors in 569 patients treated post-formulary (14.1%) compared with 92 dosing errors in 497 patients treated pre-formulary (18.5%), risk difference -4.5% (95% CI -8.9 to 0.0), p = 0.049. Among 304 paramedic survey respondents who had experience with the formulary, anxiety decreased (p < 0.001) and confidence increased (p < 0.001) post-formulary. Paramedics expressed the challenges of pediatric calls, the benefits of the MCG with the standardized formulary, and the ongoing challenges of pediatric medication dosing. Benefits included simplifying paramedic tasks, increasing paramedic self-efficacy, facilitating provider communication, and improving patient care.Conclusion: Implementation of a MCG with standardized formulary and pre-calculated medication dosing by weight reduced pediatric medication dosing errors and increased paramedic confidence in pediatric medication dosing. It may have the potential to facilitate patient care through improved communications and task simplification.
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Affiliation(s)
- Nichole Bosson
- Received June 9, 2021 from Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California (NM, MG-H); Department of Emergency Medicine, Harbor-UCLA Medical Center and, the Lundquist Institute, Torrance, California (NM, AHM); David Geffen School of Medicine at UCLA, Los Angeles, California (NM, AHM, MG-H). Revision received July 6, 2021; accepted for publication July 6, 2021
| | - Amy H Kaji
- Received June 9, 2021 from Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California (NM, MG-H); Department of Emergency Medicine, Harbor-UCLA Medical Center and, the Lundquist Institute, Torrance, California (NM, AHM); David Geffen School of Medicine at UCLA, Los Angeles, California (NM, AHM, MG-H). Revision received July 6, 2021; accepted for publication July 6, 2021
| | - Marianne Gausche-Hill
- Received June 9, 2021 from Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California (NM, MG-H); Department of Emergency Medicine, Harbor-UCLA Medical Center and, the Lundquist Institute, Torrance, California (NM, AHM); David Geffen School of Medicine at UCLA, Los Angeles, California (NM, AHM, MG-H). Revision received July 6, 2021; accepted for publication July 6, 2021
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7
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Kamzan AD, Ng E. When Less is More: The Role of Overdiagnosis and Overtreatment in Patient Safety. Adv Pediatr 2021; 68:21-35. [PMID: 34243853 DOI: 10.1016/j.yapd.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Audrey D Kamzan
- Division of Pediatric Hospital Medicine, Mattel Children's Hospital, 10833 LeConte Avenue, A2-383 MDCC, Los Angeles, CA 90095, USA; David Geffen School of Medicine at the University of California, Los Angeles, 10833 Le Conte Avenue, A2-383 MDCC, Los Angeles, CA 90095, USA.
| | - Elayna Ng
- Division of Pediatric Hospital Medicine, Mattel Children's Hospital, 10833 LeConte Avenue, A2-383 MDCC, Los Angeles, CA 90095, USA; David Geffen School of Medicine at the University of California, Los Angeles, 10833 Le Conte Avenue, A2-383 MDCC, Los Angeles, CA 90095, USA
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8
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Chung SL. Pediatric Health Information Technology-What We Need for Optimal Care of Children. Appl Clin Inform 2021; 12:708-709. [PMID: 34320684 DOI: 10.1055/s-0041-1732405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sandy L Chung
- Pediatric Health Network, Children's National Hospital, Washington, District of Columbia., United States
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Howlett MM, Butler E, Lavelle KM, Cleary BJ, Breatnach CV. The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study. Appl Clin Inform 2020; 11:323-335. [PMID: 32375194 DOI: 10.1055/s-0040-1709508] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)-facilitated by smart-pump technology-were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. OBJECTIVE The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. METHODS A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. RESULTS A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. CONCLUSION The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.
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Affiliation(s)
- Moninne M Howlett
- Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Children's Research Centre, Crumlin, Dublin, Ireland
| | - Eileen Butler
- Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Karen M Lavelle
- Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Brian J Cleary
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Pharmacy, The Rotunda Hospital, Parnell Square, Dublin, Ireland
| | - Cormac V Breatnach
- Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
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Unal A, Intepeler SS. Medical error reporting software program development and its impact on pediatric units' reporting medical errors. Pak J Med Sci 2019; 36:10-15. [PMID: 32063923 PMCID: PMC6994913 DOI: 10.12669/pjms.36.2.732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: The purpose of this quasi-experimental study was to developing web-based, anonymous reporting system to increase reporting of medication errors, blood transfusion errors and patient falls in pediatric units and to compare the computerized system with the written system already in use at the institution. Methods: This study was conducted in all pediatric units of a research hospital. All physicians and nurses working in these units agreed to participate in the study. All units were visited to introduce the new reporting system. The number and quality of the reports sent on the new system in years 2014 and 2015 were compared to the reports sent the previous year using the written system. Results: There was considerable increase in rates of reporting: 234% increase in medication error reporting rate, and 100% increase in the reports of blood transfusion errors. One of the most important results of this study that near-miss errors were not reported at all while the written system of the study institution was being used, whereas it was the most commonly reported type of errors in the electronic error reporting system. Conclusion: The web-based reporting system, which makes reporting easy, promoted the development of safety culture among doctors and nurses in common language.
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Affiliation(s)
- Aysun Unal
- Dr. Aysun Unal, PhD, RN. Assistant Professor, Nursing Management Department, Akdeniz University Kumluca, Faculty of Health Sciences, Antalya, Turkey
| | - Seyda Seren Intepeler
- Prof. Dr. Seyda Seren Intepeler, BSN, PhD. Nursing Management Department, Dokuz Eylul University, Nursing Faculty, Izmir, Turkey
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Marañón R, Solís-García G, Ignacio Cerro C, Díaz Redondo A, Romero Martínez AI, Mora Capín A. [Evaluation of effectiveness of corrective measures arising from incident notifications in a paediatric emergency department]. J Healthc Qual Res 2019; 34:242-247. [PMID: 31713520 DOI: 10.1016/j.jhqr.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyse the effectiveness of corrective measures arising from the analysis of safety incident notifications in the Paediatric Emergency Unit. METHODS A quasi-experimental, prospective, and single-centre study was carried out between 2015 and 2018. In the first phase, incidents notified throughout one year were analysed. Corrective measures were then implemented for 5 specific kinds of incidents. These incidents were finally compared to those notified within 12 months after the implementation of those measures. Results were expressed as relative risk and relative risk reduction. RESULTS A total of 1587 safety incidents were notified (0.9% of patients treated) between January 2015 and December 2017. After implementation of corrective measures, there was a decrease in all kinds of incidents notifications analysed. The incidents related to patient identification were reduced by 60.9% (RR 0.39, 95% CI; 0.25-0.60), and those regarding communication between professionals were reduced by 74.5% (RR 0.25, 95% CI; 0.12-0.55). Incidents related to sedation and analgesic procedures totally disappeared. No significant reduction was found in incidents concerning the triage system, or in those related to rapid intravenous rehydration procedures. CONCLUSIONS The implementation of improvement actions arising from the analysis of voluntary notification of incidents is an effective strategy to improve patient effective strategy to improve.
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Affiliation(s)
- R Marañón
- Unidad de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - G Solís-García
- Unidad de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Ignacio Cerro
- Unidad de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Díaz Redondo
- Servicio de Medicina Preventiva, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A I Romero Martínez
- Unidad de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Mora Capín
- Unidad de Urgencias de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Hamilton MJ, McEniery JA, Osborne JM, Coulthard MG. Implementation and strength of root cause analysis recommendations following serious adverse events involving paediatric patients in the Queensland public health system between 2012 and 2014. J Paediatr Child Health 2019; 55:1070-1076. [PMID: 30582234 DOI: 10.1111/jpc.14344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/31/2018] [Accepted: 11/18/2018] [Indexed: 11/28/2022]
Abstract
AIM This study evaluates the implementation rate and strength of the recommendations developed in all root cause analyses (RCAs) performed following serious clinical incidents involving children that have resulted in permanent harm or death in Queensland public hospitals over a 3-year period. METHODS Severity assessment classification 1 events were identified from a Queensland Paediatric Quality Council database of paediatric clinical incidents that occurred in Queensland between 1 January 2012 and 31 December 2014. There were 150 recommendations extracted from RCAs pertaining to the 42 serious adverse events involving paediatric patients. RESULTS Of the recommendations, 82% were implemented; 33% of recommendations were classified as stronger, 33% as intermediate and 34% weaker in terms of their potential to improve patient safety. CONCLUSIONS This study describes the implementation of recommendations and classifies them in terms of potential to prevent patient harm and save lives. Future research is needed to determine if the RCA process does indeed prevent harm.
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Affiliation(s)
- Monique J Hamilton
- Academic Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
| | - Julie A McEniery
- Queensland Paediatric Quality Council, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jodie M Osborne
- Queensland Paediatric Quality Council, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Mark G Coulthard
- Academic Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia.,Queensland Paediatric Quality Council, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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13
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Ratwani RM, Savage E, Will A, Fong A, Karavite D, Muthu N, Rivera AJ, Gibson C, Asmonga D, Moscovitch B, Grundmeier R, Rising J. Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings. Health Aff (Millwood) 2019; 37:1752-1759. [PMID: 30395517 DOI: 10.1377/hlthaff.2018.0699] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pediatric populations are uniquely vulnerable to the usability and safety challenges of electronic health records (EHRs), particularly those related to medication, yet little is known about the specific issues contributing to hazards. To understand specific usability issues and medication errors in the care of children, we analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. Of the 9,000 reports, 3,243 (36 percent) had a usability issue that contributed to the medication event, and 609 (18.8 percent) of the 3,243 might have resulted in patient harm. The general pattern of usability challenges and medication errors were the same across the three sites. The most common usability challenges were associated with system feedback and the visual display. The most common medication error was improper dosing.
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Affiliation(s)
- Raj M Ratwani
- Raj M. Ratwani ( ) is director of the National Center for Human Factors in Healthcare, MedStar Health, and an assistant professor of emergency medicine, Department of Emergency Medicine, Georgetown University School of Medicine, both in Washington, D.C
| | - Erica Savage
- Erica Savage is a manager in Ambulatory Quality and Safety, MedStar Health
| | - Amy Will
- Amy Will is a research program manager at the National Center for Human Factors in Healthcare, MedStar Health
| | - Allan Fong
- Allan Fong is a research scientist at the National Center for Human Factors in Healthcare, MedStar Health
| | - Dean Karavite
- Dean Karavite is principal human computer interaction specialist, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, in Pennsylvania
| | - Naveen Muthu
- Naveen Muthu is director of the Cognitive Informatics Group, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and an instructor of pediatrics, University of Pennsylvania Perelman School of Medicine
| | - A Joy Rivera
- A. Joy Rivera is a senior human factors system engineer at the Children's Hospital of Wisconsin, in Milwaukee
| | - Cori Gibson
- Cori Gibson is a safety specialist at the Children's Hospital of Wisconsin
| | - Don Asmonga
- Don Asmonga is an officer in the Health Information Technology Initiative, Pew Charitable Trusts, in Washington, D.C
| | - Ben Moscovitch
- Ben Moscovitch is the project director of the Health Information Technology Initiative, Pew Charitable Trusts
| | - Robert Grundmeier
- Robert Grundmeier is director of clinical informatics, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and an assistant professor of pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Josh Rising
- Josh Rising is director of Healthcare Programs, Pew Health Group, Pew Charitable Trusts
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Kahn S, Abramson EL. What is new in paediatric medication safety? Arch Dis Child 2019; 104:596-599. [PMID: 30154183 DOI: 10.1136/archdischild-2018-315175] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/04/2022]
Abstract
Medication-related errors are among the most common medical errors, and studies have shown that the paediatric population is particularly vulnerable. Errors can occur during any step in the medication process. This review article seeks to highlight new advancements in the field of paediatric medication safety at each stage of the medication process, from ordering and transcribing to medication dispensing and administration. We will focus on interventions that are increasingly widely used, such as computerised provider order entry with clinical decision support, barcoding technologies and safe medication administration through technologies pumps (SMART pumps), as well as innovative mobile application devices and workflow management systems that are being piloted at single institutions. By highlighting what is new in paediatric medication safety, as well as the gaps that remain, we hope to continue to foster focus on this critically important area in order to create the safest possible environment for children.
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Affiliation(s)
- Stacie Kahn
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, USA
| | - Erika L Abramson
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, USA.,Healthcare Policy and Research, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
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15
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Mora Capín A, Rivas García A, Marañón Pardillo R, Ignacio Cerro C, Díaz Redondo A, Vázquez López P. [Impact of a strategy to improve the quality of care and risk management in a paediatric emergency department]. J Healthc Qual Res 2019; 34:78-85. [PMID: 30638906 DOI: 10.1016/j.jhqr.2018.10.003] [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] [Received: 08/07/2018] [Revised: 09/24/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Emergency departments are a high risk area for the occurrence of adverse events. The aim of this study is to analyse the impact of a strategy to improve the quality assurance and risk management in the notification of incidents in our Unit, and describe the improvement actions developed from the reported incidents. MATERIAL AND METHODS A retrospective observational study was developed during one year, divided into two periods: P1 (Start: training session and implementation of the risk management process), and P2 (Start: feed-back session of incidents reported in P1 and improvement actions developed). In each period, the number of reported incidents in relation to the number of emergencies attended (‰) and the descriptive data of each incident were recorded. The improvement actions developed from the incidents reported in P1 were described. RESULTS The number of notifications from P1 (4.1‰; 95%CI 3.2-5.0‰) increased in P2 (10.9‰; 95%CI 9.8-10.2‰, P<.001). The most frequent incidents in P1 were medication (33.3%), and identification errors (25.9%): both were significantly reduced in P2 (16.9%, P=.001 and 9.3%, P<.001, respectively). In P2, prescription errors of the P1 were reduced (35.9% vs 62.9%, P=.02). The factors of "Knowledge and training" (23.5%) were the most frequent in P1, decreasing in P2 (7.4%, P<.001). CONCLUSION It is considered that the implementation of a risk management process, and the promotion of a safety culture, through training and feed-back sessions to all professionals, contributed to increase the volume of notifications in our Unit. The voluntary and anonymous reporting of incidents is useful to identify risks, and plan corrective measures, contributing to improve quality assurance and patient safety.
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Affiliation(s)
- A Mora Capín
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España.
| | - A Rivas García
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
| | - R Marañón Pardillo
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
| | - C Ignacio Cerro
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
| | - A Díaz Redondo
- Servicio de Medicina Preventiva y Gestión de Calidad, Unidad Funcional de Gestión de Riesgos, Hospital Gregorio Marañón, Madrid, España
| | - P Vázquez López
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
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Thurtle DP, Daffron SB, Halvorson EE. Patient Characteristics Associated With Voluntary Safety Event Reporting in the Acute Care Setting. Hosp Pediatr 2019; 9:134-138. [PMID: 30630876 DOI: 10.1542/hpeds.2018-0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Adverse events are increasingly important to health care delivery and financial reimbursement. Most hospitals use voluntary event reporting (VER) systems to detect safety events, which may be vulnerable to individual and systemic biases. We tested the hypothesis that patient demographic factors such as weight status and race would be associated with safety event reporting in the acute care setting. METHODS We reviewed all acute care encounters for patients 2 to 17 years of age and corresponding safety events entered in the VER system of a tertiary-care children's hospital from February 2015 to February 2016. Data collected included patient demographics, clinical characteristics, incident description, and reported harm score. Our primary outcome was any report of a safety event. Using χ2 and multivariable logistical regression methods, we determined patient characteristics associated with safety event reporting. RESULTS A total of 22 056 patient encounters were identified, and 341 (1.5%) of those had a reported safety event. In univariate analysis, age, weight category, and race were found to be significantly associated with event reporting, whereas sex and insurance provider were not. In the multivariable logistic regression model, obesity (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.49-0.97) and African American race (OR 0.65; 95% CI 0.46-0.93) were negatively associated with event reporting, whereas length of stay was positively associated (OR 1.51; 95% CI 1.46-1.55). CONCLUSIONS We identified associations between patient demographic factors and voluntary safety event reporting in the acute care setting. In future studies, we will compare VER to event identification by more objective measures, such as a trigger tool.
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Affiliation(s)
- Danielle P Thurtle
- Department of Pediatrics, Wake Forest Shool of Medicine, Winston-Salem, North Carolina
| | - Sara B Daffron
- Department of Pediatrics, Wake Forest Shool of Medicine, Winston-Salem, North Carolina
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest Shool of Medicine, Winston-Salem, North Carolina
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Halvorson EE, Thurtle DP, Kirkendall ES. Identifying Pediatric Patients at High Risk for Adverse Events in the Hospital. Hosp Pediatr 2018; 9:67-69. [PMID: 30509901 DOI: 10.1542/hpeds.2018-0171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Eric S Kirkendall
- Department of Pediatrics and.,Center for Healthcare Innovation, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and
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Koller D, Espin S. Views of children, parents, and health-care providers on pediatric disclosure of medical errors. J Child Health Care 2018; 22:577-590. [PMID: 29558835 DOI: 10.1177/1367493518765220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the prevalence of medical errors in pediatrics, little research examines stakeholder perspectives on the disclosure of adverse events, particularly in the case of children's own perspectives. Stakeholder perspectives, however, are integral to informing processes for pediatric disclosure. Building on a systematic review of the literature, this article presents findings from a series of focus groups with key pediatric stakeholders where perspectives were sought on the disclosure of medical errors. Focus groups were conducted with three stakeholder groups. Participants included child members of the Children's Council from a large pediatric hospital (n = 14), parents of children with chronic medical conditions (n = 5), and health-care providers including physicians, nurses, and patient safety professionals (n = 27). Children acknowledged various disclosure approaches while citing the importance of children's right to know about errors. Parents generally identified the need for full disclosure and the uncovering of hidden errors. Health-care providers were concerned about the process of disclosure and whether it always served the best interest of the child or family. While some health-care providers addressed the need for more clarity in pediatric policies, most stakeholders agreed that a case-by-case approach was necessary for supporting variations in how medical errors are disclosed.
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Affiliation(s)
- Donna Koller
- The Hospital for Sick Children, Ryerson University, Toronto, Ontario, Canada
| | - Sherry Espin
- The Hospital for Sick Children, Ryerson University, Toronto, Ontario, Canada
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19
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Snyder EJ, Zhang W, Jasmin KC, Thankachan S, Donnelly LF. Gauging potential risk for patients in pediatric radiology by review of over 2,000 incident reports. Pediatr Radiol 2018; 48:1867-1874. [PMID: 30159593 DOI: 10.1007/s00247-018-4238-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/12/2018] [Accepted: 08/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Incident reporting can be used to inform imaging departments about adverse events and near misses. OBJECTIVE To study incident reports submitted during a 5-year period at a large pediatric imaging system to evaluate which imaging modalities and other factors were associated with a greater rate of filed incident reports. MATERIALS AND METHODS All incident reports filed between 2013 and 2017 were reviewed and categorized by modality, patient type (inpatient, outpatient or emergency center) and use of sedation/anesthesia. The number of incident reports was compared to the number of imaging studies performed during that time period to calculate an incident report rate for each factor. Statistical analysis of whether there were differences in these rates between factors was performed. RESULTS During the study period, there were 2,009 incident reports filed and 1,071,809 imaging studies performed for an incident report rate of 0.19%. The differences in rates by modality were statistically significant (P=0.0001). There was a greater rate of incident reports in interventional radiology (1.54%) (P=0.0001) and in magnetic resonance imaging (MRI) (0.62%) (P=0.001) as compared to other imaging modalities. There was a higher incident report rate for inpatients (0.34%) as compared to outpatient (0.1%) or emergency center (0.14%) (P=0.0001). There was a higher rate of incident reports for patients under sedation (1.27%) as compared to non-sedated (0.12%) (P=0.0001). CONCLUSION Using incident report rates as a proxy for potential patient harm, the areas of our pediatric radiology service that are associated with the greatest potential for issues are interventional radiology, sedated patients, and inpatients. The areas associated with the least risk are ultrasound (US) and radiography. Safety improvement efforts should be focused on the high-risk areas.
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Affiliation(s)
- Elizabeth J Snyder
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA.,Department of Radiology, Vanderbilt University, Nashville, TN, USA
| | - Wei Zhang
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | | | - Sam Thankachan
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Lane F Donnelly
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA. .,Center for Pediatric and Maternal Value, Lucile Packard Children's Hospital at Stanford, Stanford Children's Health, 180 El Camino Real, Ste. M384, Mail Code: 5885, Palo Alto, CA, 94304, USA. .,Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA.
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20
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Automated E-mail Reminders Linked to Electronic Health Records to Improve Medication Reconciliation on Admission. Pediatr Qual Saf 2018; 3:e109. [PMID: 30584636 PMCID: PMC6221599 DOI: 10.1097/pq9.0000000000000109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 08/15/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction: Medication reconciliation can reduce medication discrepancies, errors, and patient harm. After a large academic hospital introduced a medication reconciliation software program, there was low compliance with electronic health record documentation of home medication reconciliation. This quality improvement project aimed to improve medication reconciliation on admission in 4 pediatric inpatient units by 50% over 3 months. Methods: We used Lean Sigma methodology to observe medication reconciliation processes; interview residents, nurses, pharmacists, and families; and perform swim lane process mapping and Ishikawa Cause and Effect analysis. The improvement plan included education and automated e-mails sent to admitting residents who had not completed medication reconciliation within 24 hours of admission. The daily percentage of patients without medication reconciliation within 24 hours of admission, indicated by the presence of old prescriptions in Sunrise Prescription Writer (RxWriter) (Allscripts Healthcare Solutions, Chicago, Ill.) from prior admissions, was assessed from March 2015-June 2016. We constructed statistical process control charts and identified special causes. Results: Key barriers included lack of knowledge about RxWriter and lack of accountability for completing medication reconciliation. The percentage of patients without medication reconciliation decreased from 32% at baseline to 22% with education (P < 0.001), to 15% with the use of automated e-mail reminders (P < 0.001). We sustained improvement over the following year. Statistical process control testing indicated shifts aligning with each stage of the study. Conclusion: Provider-tailored, automated e-mail reminders linked to electronic health record with educational training significantly improved resident compliance with use of an electronic tool for documentation of home medication reconciliation on hospital admission.
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Hessels AJ, Darby SW, Simpser E, Saiman L, Larson EL. National Testing of the Nursing-Kids Intensity of Care Survey for Pediatric Long-term Care. J Pediatr Nurs 2017; 37:86-90. [PMID: 28869067 PMCID: PMC5681364 DOI: 10.1016/j.pedn.2017.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/17/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to test the Nursing-Kids Intensity of Care, a measure of the intensity of nursing care needs, defined as the quantity and type of direct and indirect care activities performed by caregivers in a national sample. DESIGN AND METHODS A 40-item tool previously tested in a small sample was psychometrically tested on a sample of 116 children with complex medical conditions by 33 nurse raters across 11 pediatric sites. RESULTS The Nursing-Kids Intensity of Care tool demonstrated components of usability, feasibility, inter-rater, test-retest and internal consistency reliability and construct validity in the national study sample. CONCLUSIONS Additional testing to further establish psychometric sufficiency and expanded use to quantify the intensity of nursing care needs of children with complex medical conditions in pediatric long-term care settings is recommended. PRACTICE IMPLICATIONS This novel measure could assist the nursing administrators, educators and staff of pediatric long-term care facilities assess the intensity of care needs of their residents.
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Affiliation(s)
- Amanda J Hessels
- Columbia University, School of Nursing, New York, NY, USA; Hackensack Meridian Health, Ann May Center for Nursing, Neptune, NJ, USA.
| | - Sharon W Darby
- Children's Hospital of Richmond at VCU, Richmond, VA, USA.
| | - Edwin Simpser
- St. Mary's Healthcare System for Children, New York, USA.
| | - Lisa Saiman
- Columbia University Medical Center, Pediatric Infectious Diseases, New York, NY, USA.
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Sousa FCPD, Montenegro LC, Goveia VR, Corrêa ADR, Rocha PK, Manzo BF. A PARTICIPAÇÃO DA FAMÍLIA NA SEGURANÇA DO PACIENTE EM UNIDADES NEONATAIS NA PERSPECTIVA DO ENFERMEIRO. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017001180016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: compreender a influência da participação da família na segurança do paciente em unidades neonatais na perspectiva de enfermeiros. Método: estudo descritivo de abordagem qualitativa, realizado na unidade de cuidados intermediários e na unidade de cuidados intensivos Neonatais de uma maternidade pública de Belo Horizonte-MG, tendo 14 enfermeiros como participantes do estudo. Os dados foram coletados por meio de entrevistas com roteiros semiestruturados, os quais foram submetidos à análise de conteúdo temática. Resultados: os enfermeiros reconhecem a participação da família na segurança do paciente neonatal, porém demonstraram despreparo e pouca compreensão ao lidar com esse familiar no cotidiano de trabalho. Ainda apontaram o acolhimento e a orientação dos familiares como estratégias significativas para o cuidado seguro. Conclusões: acredita-se que inserir os familiares como parceiros críticos e ativos das práticas dos profissionais de saúde seja uma estratégia importante e promissora para a promoção de saúde e segurança do paciente.
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Wagner M, Mileder LP, Goeral K, Klebermass-Schrehof K, Cardona FS, Berger A, Schmölzer GM, Olischar M. Student peer teaching in paediatric simulation training is a feasible low-cost alternative for education. Acta Paediatr 2017; 106:995-1000. [PMID: 28244140 DOI: 10.1111/apa.13792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 02/17/2017] [Indexed: 11/29/2022]
Abstract
AIM The World Health Organization recommends regular simulation training to prevent adverse healthcare events. We used specially trained medical students to provide paediatric simulation training to their peers and assessed feasibility, cost and confidence of students who attended the courses. METHODS Students at the Medical University of Vienna, Austria were eligible to participate. Students attended two high-fidelity simulation training sessions, delivered by peers, which were videorecorded for evaluation. The attendees then completed questionnaires before and after the training. Associated costs and potential benefits were analysed. RESULTS From May 2013 to June 2015, 152 students attended the sessions and 57 (37.5%) completed both questionnaires. Satisfaction was high, with 95% stating their peer tutor was competent and 90% saying that peer tutors were well prepared. The attendees' confidence in treating critically ill children significantly improved after training (p < 0.001). The average costs for a peer tutor were six Euros per working hour, compared to 35 Euros for a physician. CONCLUSION Using peer tutors for paediatric simulation training was a feasible and low-cost option that increased the number of medical students who could be trained and increased the self-confidence of the attendees. Satisfaction with the peer tutors was high.
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Affiliation(s)
- Michael Wagner
- Division of Neonatology; Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Lukas P. Mileder
- Division of Neonatology; Department of Paediatrics and Adolescent Medicine; Medical University of Graz; Graz Austria
| | - Katharina Goeral
- Division of Neonatology; Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology; Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Francesco S. Cardona
- Division of Neonatology; Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Angelika Berger
- Division of Neonatology; Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Georg M. Schmölzer
- Department of Paediatrics; University of Alberta; Edmonton Alberta Canada
- Centre for the Studies of Asphyxia and Resuscitation; Royal Alexandra Hospital; Alberta Health Services; Edmonton Alberta Canada
| | - Monika Olischar
- Division of Neonatology; Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
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Abstract
OBJECTIVES Children with complex medical needs are increasing in number and demanding the services of pediatric long-term care facilities (pLTC), which require a focus on patient safety culture (PSC). However, no tool to measure PSC has been tested in this unique hybrid acute care-residential setting. The objective of this study was to evaluate the psychometric properties of the Nursing Home Survey on Patient Safety Culture tool slightly modified for use in the pLTC setting. METHODS Factor analyses were performed on data collected from 239 staff at 3 pLTC in 2012. Items were screened by principal axis factoring, and the original structure was tested using confirmatory factor analysis. Exploratory factor analysis was conducted to identify the best model fit for the pLTC data, and factor reliability was assessed by Cronbach alpha. RESULTS The extracted, rotated factor solution suggested items in 4 (staffing, nonpunitive response to mistakes, communication openness, and organizational learning) of the original 12 dimensions may not be a good fit for this population. Nevertheless, in the pLTC setting, both the original and the modified factor solutions demonstrated similar reliabilities to the published consistencies of the survey when tested in adult nursing homes and the items factored nearly identically as theorized. CONCLUSIONS This study demonstrates that the Nursing Home Survey on Patient Safety Culture with minimal modification may be an appropriate instrument to measure PSC in pLTC settings. Additional psychometric testing is recommended to further validate the use of this instrument in this setting, including examining the relationship to safety outcomes. Increased use will yield data for benchmarking purposes across these specialized settings to inform frontline workers and organizational leaders of areas of strength and opportunity for improvement.
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Pound CM, Gelt V, Akiki S, Eady K, Moreau K, Momoli F, Murchison B, Zemek R, Mulholland B, Kovesi T. Nurse-Driven Clinical Pathway for Inpatient Asthma: A Randomized Controlled Trial. Hosp Pediatr 2017; 7:204-213. [PMID: 28330941 DOI: 10.1542/hpeds.2016-0150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We examined the impact of a nurse-driven clinical pathway on length of stay (LOS) for children hospitalized with asthma. METHODS We conducted a randomized controlled trial involving children hospitalized with asthma. Nurses of children in the intervention group weaned salbutamol frequency using an asthma scoring tool, whereas physicians weaned salbutamol frequency for the control group patients as per standard care. The primary outcome was LOS in hours. Secondary outcomes included number of salbutamol treatments administered, ICU transfers, unplanned medical visits postdischarge, and stakeholders' pathway satisfaction. Research staff, investigators, and statisticians were blinded to group assignment, except for research assistants enrolling participants. Qualitative interviews were done to assess acceptability of intervention by physicians, nurses, residents, and patients. RESULTS We recruited 113 participants (mean age 4.9 years, 62% boys) between May 2012 and September 2015. Median LOS was 49 hours (21-243 hours) and 47 hours (22-188 hours) (P = .11), for the control and intervention groups, respectively. A post hoc analysis designed to deal with highly skewed LOS data resulted in a relative 18% (95% confidence interval 0.68-0.99) LOS reduction for the intervention group. There was no difference in secondary outcomes. No significant adverse events resulted from the intervention. The 14 participants included in the qualitative component reported a positive experience with the pathway. CONCLUSIONS This nurse-driven pathway led to increased efficiency as evidenced by a modest LOS reduction. It allowed for care standardization, improved utilization of nursing resources, and high stakeholder satisfaction.
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Affiliation(s)
- Catherine M Pound
- Children's Hospital of Eastern Ontario, Ontario, Canada; .,University of Ottawa, Ontario, Canada; and
| | - Victoria Gelt
- Children's Hospital of Eastern Ontario, Ontario, Canada.,University of Ottawa, Ontario, Canada; and
| | - Salwa Akiki
- Children's Hospital of Eastern Ontario, Ontario, Canada
| | - Kaylee Eady
- University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Katherine Moreau
- University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Franco Momoli
- University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Barbara Murchison
- Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario, Ontario, Canada.,University of Ottawa, Ontario, Canada; and.,Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
| | | | - Tom Kovesi
- Children's Hospital of Eastern Ontario, Ontario, Canada.,University of Ottawa, Ontario, Canada; and
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Saddi V, Preddy J, Dalton S, Connors J, Patterson S. Variation in Gentamicin Dosing and Monitoring in Pediatric Units across New South Wales. Pediatr Qual Saf 2017; 2:e015. [PMID: 30229154 PMCID: PMC6132910 DOI: 10.1097/pq9.0000000000000015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/10/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Gentamicin is an aminoglycoside antibiotic with broad-spectrum bactericidal activity and is widely used in pediatric units to treat infection with susceptible organisms. This study aimed to describe the dosage regimen for gentamicin and approach to its therapeutic drug monitoring (TDM) among the pediatric units within the state of New South Wales (NSW). METHODS A questionnaire was sent electronically to representatives of 40 pediatric units in NSW, requesting details of each unit's gentamicin dosing and TDM policy. RESULTS A total of 35 units responded to the survey. The majority (63%) of the units used a dose of 7.5 mg/kg of gentamicin in patients with normal renal function. More than half of the units (54%) did not have a local gentamicin dosing protocol and relied on other sources for dosing regimens. Dosing responses varied from a dose of 6 mg/kg once daily for patients more than 10 years of age to 7 mg/kg once daily on day 1, followed by 5 mg/kg once daily for patients over 10 years of age. For TDM of gentamicin, 63% of units indicated use of trough levels and 23% units used the Hartford Nomogram. CONCLUSIONS A significant variation exists in clinical practice among pediatric units in NSW on gentamicin dosing and TDM guidelines. There is an urgent need for collaboration among nursing, medical, and pharmacy experts to achieve consensus to develop and adopt statewide uniform guidelines on gentamicin dosing and TDM.
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Affiliation(s)
- Vishal Saddi
- From the Department of Paediatrics, Sydney Children’s Hospital, Randwick; Discipline of Paediatrics and Child Health, University of New South Wales, Rural Medical School, Wagga Wagga; and Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - John Preddy
- From the Department of Paediatrics, Sydney Children’s Hospital, Randwick; Discipline of Paediatrics and Child Health, University of New South Wales, Rural Medical School, Wagga Wagga; and Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Sarah Dalton
- From the Department of Paediatrics, Sydney Children’s Hospital, Randwick; Discipline of Paediatrics and Child Health, University of New South Wales, Rural Medical School, Wagga Wagga; and Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - John Connors
- From the Department of Paediatrics, Sydney Children’s Hospital, Randwick; Discipline of Paediatrics and Child Health, University of New South Wales, Rural Medical School, Wagga Wagga; and Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Sarah Patterson
- From the Department of Paediatrics, Sydney Children’s Hospital, Randwick; Discipline of Paediatrics and Child Health, University of New South Wales, Rural Medical School, Wagga Wagga; and Clinical Excellence Commission, Sydney, New South Wales, Australia
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Dadlez NM, Azzarone G, Sinnett MJ, Resnick M, Ushay HM, Adelman JS, Broder M, Duh-Leong C, Huang J, Kiely V, Nadler A, Nelson V, Simcik J, Rinke ML. Ordering Interruptions in a Tertiary Care Center: A Prospective Observational Study. Hosp Pediatr 2017; 7:134-139. [PMID: 28148543 DOI: 10.1542/hpeds.2016-0127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES By self-report, interruptions may contribute to up to 80% of ordering errors. A greater understanding of the frequency and context of interruptions during ordering is needed to identify targets for intervention. We sought to characterize the epidemiology of interruptions during order placement in the pediatric inpatient setting. METHODS This prospective observational study conducted 1-hour-long structured observations on morning rounds and afternoons and evenings in the resident workroom. The primary outcome was the number of interruptions per 100 orders placed by residents and physician assistants. We assessed the role of ordering provider, number, type and urgency of interruptions and person initiating interruption. Descriptive statistics, χ2, and run charts were used. RESULTS Sixty-nine structured observations were conducted with a total of 414 orders included. The interruption rate was 65 interruptions per 100 orders during rounds, 55 per 100 orders in the afternoons and 56 per 100 orders in the evenings. The majority of interruptions were in-person (n = 144, 61%). Interruptions from overhead announcements occurred most often in the mornings, and phone interruptions occurred most often in the evenings (P = .002). Nurses initiated interruptions most frequently. Attending physicians and fellows were more likely to interrupt during rounds, and coresidents were more likely to interrupt in the evenings (P = .002). CONCLUSIONS Residents and physician assistants are interrupted at a rate of 57 interruptions per 100 orders placed. This may contribute to ordering errors and worsen patient safety. Efforts should be made to decrease interruptions during the ordering process and track their effects on medication errors.
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Affiliation(s)
- Nina M Dadlez
- The Children's Hospital at Montefiore, Bronx, New York; .,Albert Einstein College of Medicine, Bronx, New York
| | - Gabriella Azzarone
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Mark J Sinnett
- The Children's Hospital at Montefiore, Bronx, New York.,Montefiore Medical Center, Bronx, New York
| | - Micah Resnick
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - H Michael Ushay
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Jason S Adelman
- Montefiore Medical Center, Bronx, New York.,NewYork-Presbyterian Hospital, New York, New York; and.,Columbia University College of Physicians and Surgeons, New York, New York
| | - Molly Broder
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Carol Duh-Leong
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Joyce Huang
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | | | - Ariella Nadler
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Vayola Nelson
- The Children's Hospital at Montefiore, Bronx, New York
| | - Jared Simcik
- The Children's Hospital at Montefiore, Bronx, New York
| | - Michael L Rinke
- The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
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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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Abstract
Despite increasing attention to issues of patient safety, preventable adverse events (AEs) continue to occur, causing direct and consequential injuries to patients, families, and health care providers. Pediatricians generally agree that there is an ethical obligation to inform patients and families about preventable AEs and medical errors. Nonetheless, barriers, such as fear of liability, interfere with disclosure regarding preventable AEs. Changes to the legal system, improved communications skills, and carefully developed disclosure policies and programs can improve the quality and frequency of appropriate AE disclosure communications.
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Mojica E, Izarzugaza E, Gonzalez M, Astobiza E, Benito J, Mintegi S. Elaboration of a risk map in a paediatric Emergency Department of a teaching hospital. Emerg Med J 2016; 33:684-9. [PMID: 27323790 DOI: 10.1136/emermed-2015-205336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop a risk map in a paediatric ED of a tertiary teaching hospital, combining proactive and reactive strategies. METHODS Between June and December 2013, a multidisciplinary committee in a paediatric Emergency Department (ED) in Bilbao (Basque Country of Spain) mapped the patient's journey and identified potential risks to patients (proactive strategy). The researchers also analysed incidents reported by professionals and caregivers (mainly parents) in the paediatric ED from November 2004-December 2013 (reactive strategies). Combining the results of both strategies, we applied the 'Failure mode and effects analysis' tool to identify and prioritise high or very high-risk situations and apply them to the risk map. RESULTS Using proactive strategies, 49 opportunities for failures, 60 effects and 252 causes were identified. The most common failures were related to the discharge of the patient; the most common effects were complaints by parents, long stay in the ED, delay in diagnosis/treatment and unnecessary treatment. Main causes were not including the family in the process, shift change, incorrect identification of the patient and computer errors. Using reactive strategies, 1795 reported incidents were analysed. The most common incidents were related to medical equipment (38%), resources/organisation of staff (17%), clinical process (15%), facilities (12%) and medication errors (5%). Proactive strategies identified risks in tests, treatment and discharge. The reactive strategy added risks concerning prehospital transfer, triage, medical care, tests, treatment and discharge. CONCLUSIONS Proactive and reactive strategies, involving professionals and caregivers, can complement each other in identifying potential patient safety risks in a paediatric ED.
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Affiliation(s)
- Elisa Mojica
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain
| | - Estibaliz Izarzugaza
- Quality Department, Cruces University Hospital. University of the Basque Country Bilbao, Bilbao, Basque Country, Spain
| | - Maria Gonzalez
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain
| | - Eider Astobiza
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain University of the Basque Country, Bilbao, Basque Country, Spain
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain University of the Basque Country, Bilbao, Basque Country, Spain
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New technologies as a strategy to decrease medication errors: how do they affect adults and children differently? World J Pediatr 2016; 12:28-34. [PMID: 26684316 DOI: 10.1007/s12519-015-0067-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/12/2014] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medication error can occur throughout the drug treatment process, with special relevance in children given the risk of adverse effects resulting from a medication error is more prevalent than in adults. The significance of medication error in children is also greater because small error that would be tolerated in adults can cause significant damage in children. Moreover, the likelihood of injury is higher than in adults. DATA SOURCES Based on the data published, most medication errors take place in prescribing and administration stages in both populations. Taking in account that child's risk factors are different from those of adults, with some specific causes to pediatrics, we have reviewed available data about new technologies as a strategy to reduce pediatric medication errors. RESULTS Even though there is a lack of standardized definitions and terminology that makes studies difficult to compare, we checked that new technologies have proven to be effectives in reducing medication errors, mainly computerized physician order entry (CPOE) and platforms to aid decision-making. However, we also observed that the use of these informatic tools can also generate new errors. CONCLUSIONS Implementation of CPOE programs for pediatrics, communication improvement between healthcare professionals taking care of admitted children and the knowledge of these programs should be the mayor priorities for the safety of hospitalized children.
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Algaze CA, Wood M, Pageler NM, Sharek PJ, Longhurst CA, Shin AY. Use of a Checklist and Clinical Decision Support Tool Reduces Laboratory Use and Improves Cost. Pediatrics 2016; 137:peds.2014-3019. [PMID: 26681782 DOI: 10.1542/peds.2014-3019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We hypothesized that a daily rounding checklist and a computerized order entry (CPOE) rule that limited the scheduling of complete blood cell counts and chemistry and coagulation panels to a 24-hour interval would reduce laboratory utilization and associated costs. METHODS We performed a retrospective analysis of these initiatives in a pediatric cardiovascular ICU (CVICU) that included all patients with congenital or acquired heart disease admitted to the cardiovascular ICU from September 1, 2008, until April 1, 2011. Our primary outcomes were the number of laboratory orders and cost of laboratory orders. Our secondary outcomes were mortality and CVICU and hospital length of stay. RESULTS We found a reduction in laboratory utilization frequency in the checklist intervention period and additional reduction in the CPOE intervention period [complete blood count: 31% and 44% (P < .0001); comprehensive chemistry panel: 48% and 72% (P < .0001); coagulation panel: 26% and 55% (P < .0001); point of care blood gas: 43% and 44% (P < .0001)] compared with the preintervention period. Projected yearly cost reduction was $717,538.8. There was no change in adjusted mortality rate (odds ratio 1.1, 95% confidence interval 0.7-1.9, P = .65). CVICU and total length of stay (days) was similar in the pre- and postintervention periods. CONCLUSIONS Use of a daily checklist and CPOE rule reduced laboratory resource utilization and cost without adversely affecting adjusted mortality or length of stay. CPOE has the potential to hardwire resource management interventions to augment and sustain the daily checklist.
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Affiliation(s)
| | | | - Natalie M Pageler
- Division of Systems Medicine, and Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Paul J Sharek
- Center for Quality and Clinical Effectiveness, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Christopher A Longhurst
- Division of Systems Medicine, and Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
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33
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Cardona AU, Cantero MP. Seguridad hospitalaria en pediatría. An Pediatr (Barc) 2015; 83:227-8. [DOI: 10.1016/j.anpedi.2015.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022] Open
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34
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Vilà de Muga M, Serrano Llop A, Rifé Escudero E, Jabalera Contreras M, Luaces Cubells C. Impact on the improvement of paediatric emergency services using a standardised model for the declaration and analysis of incidents. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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35
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Urda Cardona A, Peláez Cantero M. Hospital safety in paediatrics. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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36
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Tase TH, Tronchin DMR. Sistemas de identificação de pacientes em unidades obstétricas e a conformidade das pulseiras. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo Avaliar a conformidade das pulseiras de identificação de mulheres na clínica obstétrica e seus neonatos no centro obstétrico. Métodos Estudo quantitativo, com casuística de 800 oportunidades, selecionadas por amostragem probabilística. A coleta de dados ocorreu mediante formulário preenchido à beira-leito. O teste Qui-quadrado foi utilizado para comparar as conformidades entre as unidades e adotado o intervalo de confiança de 95%. Resultados A conformidade geral foi de 58,5% na Clínica e 22,3% no Centro Obstétrico. Quanto às três etapas do protocolo, a maior conformidade na Clínica correspondeu à etapa componentes de identificação (93,4%) e a menor, às condições da pulseira (70%); no Centro Obstétrico, os maiores índices também foram nessas etapas 69% e 44,5%, respectivamente. Na comparação entre as unidades, a Clínica obteve melhores índices conformidade, diferença estatisticamente significante. Conclusão Os achados possibilitaram reestruturar os protocolos e implementá-los na Instituição.
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Abstract
OBJECTIVE To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice. DESIGN One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process. SETTING Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey. PARTICIPANTS Pediatric critical care nurses and nurse scientists attending the open consensus meeting. INTERVENTIONS Systematic review, gap analysis, and interactive multivoting. MEASUREMENTS AND MAIN RESULTS The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children. CONCLUSIONS The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.
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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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39
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Vilà de Muga M, Serrano Llop A, Rifé Escudero E, Jabalera Contreras M, Luaces Cubells C. [Impact on the improvement of paediatric emergency services using a standardised model for the declaration and analysis of incidents]. An Pediatr (Barc) 2015; 83:248-56. [PMID: 25582063 DOI: 10.1016/j.anpedi.2014.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The aim of this study is to analyse changes in the incidents reported after the implementation of a new model, and study its results on patient safety. PATIENTS AND METHODS In 2012 an observational study with prospective collection of incidents reported between 2007 and 2011 was conducted. In May 2012 a model change was made in order to increase the number of reports, analyse their causes, and improve the feedback to the service. Professional safety representatives were assigned to every department, information and diffusion sessions were held, and a new incident reporting system was implemented. With the new model, a new observational study with prospective collection of the reports during one year was initiated, and the results compared between models. RESULTS In 2011, only 19 incidents were reported in the Emergency Department, and between June 1, 2012 to June 1, 2013, 106 incidents (5.6 times more). The incidents reported were medication incidents (57%), identification (26%), and procedures (7%). The most frequent causes were human (70.7%), lack of training (22.6%), and working conditions (15.1%). Some measures were implemented as a result of these incidents: a surgical checklist, unit doses of salbutamol, tables of weight-standardised doses of drugs for cardiopulmonary resuscitation. CONCLUSIONS The new model of reporting incidents has enhanced the reports and has allowed improvements and the implementation of preventive measures, increasing the patient safety in the Emergency Department.
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Affiliation(s)
- M Vilà de Muga
- Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - A Serrano Llop
- Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - E Rifé Escudero
- Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - M Jabalera Contreras
- Área de Seguridad, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - C Luaces Cubells
- Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.
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40
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Hughes BP, Newstead S, Anund A, Shu CC, Falkmer T. A review of models relevant to road safety. ACCIDENT; ANALYSIS AND PREVENTION 2015; 74:250-270. [PMID: 24997016 DOI: 10.1016/j.aap.2014.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 04/15/2014] [Accepted: 06/06/2014] [Indexed: 06/03/2023]
Abstract
It is estimated that more than 1.2 million people die worldwide as a result of road traffic crashes and some 50 million are injured per annum. At present some Western countries' road safety strategies and countermeasures claim to have developed into 'Safe Systems' models to address the effects of road related crashes. Well-constructed models encourage effective strategies to improve road safety. This review aimed to identify and summarise concise descriptions, or 'models' of safety. The review covers information from a wide variety of fields and contexts including transport, occupational safety, food industry, education, construction and health. The information from 2620 candidate references were selected and summarised in 121 examples of different types of model and contents. The language of safety models and systems was found to be inconsistent. Each model provided additional information regarding style, purpose, complexity and diversity. In total, seven types of models were identified. The categorisation of models was done on a high level with a variation of details in each group and without a complete, simple and rational description. The models identified in this review are likely to be adaptable to road safety and some of them have previously been used. None of systems theory, safety management systems, the risk management approach, or safety culture was commonly or thoroughly applied to road safety. It is concluded that these approaches have the potential to reduce road trauma.
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Affiliation(s)
- B P Hughes
- School of Occupational Therapy & Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.
| | - S Newstead
- Monash University Accident Research Centre, Monash Injury Research Institute, Monash University, Melbourne, Australia
| | - A Anund
- Swedish Road and Transport Research Institute, 581 95 Linköping, Sweden
| | - C C Shu
- Neurodegenerative Disorders Research Pty Ltd., Perth, Australia
| | - T Falkmer
- School of Occupational Therapy & Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia; Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, UHL, County Council, Linköping, Sweden
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41
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Cassar Flores A, Marshall S, Cordina M. Use of the Delphi technique to determine safety features to be included in a neonatal and paediatric prescription chart. Int J Clin Pharm 2014; 36:1179-89. [PMID: 25311050 DOI: 10.1007/s11096-014-0014-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal and paediatric patients are especially vulnerable to serious injury as a result of medication errors due to their small size, physiological immaturity and limited compensatory abilities. The prescription chart remains an essential form of communication of prescribing decisions and instructions. Modifications to the safety features of prescription charts have been shown to reduce the frequency of medication errors. OBJECTIVE To determine, using the Delphi technique, which safety features should be included in the inpatient neonatal and paediatric prescription chart to help minimise the risk of medication errors associated with the use of the chart. SETTING Acute general hospital in Malta. METHOD A two-round modified e-Delphi process was conducted. The Delphi questionnaire was developed from a mapping process, a literature search and references supporting the literature review. It comprised 155 safety features for consensus. The Delphi panel consisted of nine doctors, five nurses and four pharmacists. Participants were asked to rate their agreement to the inclusion of these features in the local chart using a three-point Likert scale, and to add further comments as necessary at the end of each section. In the second round, participants were given the opportunity to change their individual response in view of the groups' response. MAIN OUTCOME MEASURE This was set at a 70% level of agreement. RESULTS Results from each round were analysed to provide the percentage frequencies and number of participants who chose each point from the Likert scale provided, and the response count for each safety feature. A ≥70% consensus level was achieved on: 115 safety features in Round 1 (total: 155 safety features) and 23 safety features in Round 2 (total: 40 safety features) while only 17 safety features did not achieve consensus at the end of the process. CONCLUSION Consensus was achieved on 133 safety features to be included in the neonatal and paediatric prescription chart. Five safety features achieved consensus disagreement for their inclusion in the chart. Identifying the appropriate safety features forms part of an essential strategy to reduce the incidence of medication errors associated with the use of the chart in these patients.
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Affiliation(s)
- A Cassar Flores
- Medicines Information and Clinical Pharmacy Section, Mater Dei Hospital, Msida, Malta,
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Gaensbauer JT, Birkholz M, Pfannenstein K, Todd JK. Herpes PCR testing and empiric acyclovir use beyond the neonatal period. Pediatrics 2014; 134:e651-6. [PMID: 25113288 DOI: 10.1542/peds.2014-0294] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diagnostic strategies based on empirical testing and treatment to identify herpes simplex virus (HSV) infection in neonates may not be appropriate for older children in whom the most common presentation of severe infection is encephalitis, a rare and clinically recognizable condition. METHODS Use of acyclovir in infants and children in 6 common non-HSV infection-related diagnosis-related groups was characterized between 1999 and 2012 at 15 US pediatric hospitals by using the Pediatric Health Information System database. Characteristics of non-neonatal patients at 1 institution tested for HSV encephalitis over a 6.5-year period were then analyzed to identify factors associated with potentially unnecessary testing and treatment. RESULTS Acyclovir use increased from 7.6% to 15.6% (P < .001) from 1999 to 2012. Much of this increase came in infants 30 to 60 days of age (82.7% increase, P < .001) and in patients with milder disease severity (44.8% increase, P < .001). Length of stay was increased by 2 days for children treated with acyclovir (P < .001). At our institution, 1394 HSV cerebrospinal fluid polymerase chain reactions were performed in children >30 days old, with only 3 positive results (0.22%). Comparison of the 3 subjects with positive testing and 55 with negative testing revealed that all cases, but only 4% (95% confidence interval 1.2%-14.0%) of noncases had clinical characteristics typical of HSV encephalitis. CONCLUSIONS Strategies for diagnosis and empirical treatment of suspected HSV encephalitis beyond the neonatal period have trended toward the approach common for neonates without evidence of an increase in disease incidence. This may result in increased medical costs and risk to patients.
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Affiliation(s)
- James T Gaensbauer
- Divison of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Meghan Birkholz
- Department of Epidemiology, Children's Hospital Colorado, Aurora, Colorado
| | - Kari Pfannenstein
- Department of Epidemiology, Children's Hospital Colorado, Aurora, Colorado
| | - James K Todd
- Divison of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and Department of Epidemiology, Children's Hospital Colorado, Aurora, Colorado
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Cifra CL, Jones KL, Ascenzi J, Bhalala US, Bembea MM, Fackler JC, Miller MR. The morbidity and mortality conference as an adverse event surveillance tool in a paediatric intensive care unit. BMJ Qual Saf 2014; 23:930-8. [PMID: 25038037 DOI: 10.1136/bmjqs-2014-003000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine if standardised chart review applied to records of patients discussed at a paediatric intensive care unit (PICU) morbidity and mortality conference (MMC) yields additional or different information regarding safety event occurrence and characteristics. DESIGN Retrospective record review. SETTING Single tertiary referral PICU in Baltimore, Maryland, USA. PARTICIPANTS 96 patients discussed at the PICU MMC over 14 months (November 2011-December 2012). MAIN OUTCOME MEASURES Safety events and their characteristics (medical error category, severity and preventability). RESULTS A total of 275 safety events were identified through the MMC and/or chart review. The MMC identified 131 (48%) events, 53 (19%) of which were identified through the MMC alone. After chart review was performed, an additional 144 (52%) events were identified. 78 (28%) events were identified through both. High severity adverse events potentially contributing to permanent harm or death were more likely to be identified through both the MMC and chart review (47%) compared with either alone. The MMC alone identified more near-misses (21%) and preventable events (96%) compared with chart review alone or both MMC and chart review. Although chart review alone helped to identify many healthcare-associated infections, medication errors and sedation/pain control issues not elicited through the MMC, the MMC alone identified more communication errors and workflow problems. The MMC alone also identified 40% of all diagnostic errors, which would not have been discovered otherwise despite chart review by itself identifying 50% of such misdiagnoses. CONCLUSIONS Standardised chart review applied to records of patients discussed at a PICU MMC identified significantly more safety events not initially discovered through the MMC. However, the MMC was superior to chart review in identifying broader problems such as communication errors, workflow issues and certain diagnostic errors not captured by chart review, which can potentially affect many aspects of care.
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Affiliation(s)
| | - Kareen L Jones
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Judith Ascenzi
- Pediatric Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Utpal S Bhalala
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - James C Fackler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marlene R Miller
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
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Robinson CA, Siu A, Meyers R, Lee BH, Cash J. Standard dose development for medications commonly used in the neonatal intensive care unit. J Pediatr Pharmacol Ther 2014; 19:118-26. [PMID: 25024672 DOI: 10.5863/1551-6776-19.2.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To establish standardized, rounded doses of medications for neonates in the neonatal intensive care unit (NICU) through a multi-institutional peer-reviewed process. METHODS Pediatric faculty and pediatric pharmacy residents from the Ernest Mario School of Pharmacy (Piscataway, NJ) conducted a systematic review of rounded, weight-based medication information for neonatal patients from September 2010 to April 2011. After initial review, an expanded workgroup of expert neonatal pharmacy clinicians from academic institutions throughout the United States were invited to conduct a final review. The workgroup identified 74 medications or indications in the NICU. Recommended standardized doses were established for discrete weight categories at workgroup consensus web meetings conducted from June to December 2011. Workgroup recommendations were cross-referenced with published neonatal pharmacology resources. Consensus was obtained when references provided insufficient information on medication information. RESULTS Seventeen weight categories of increasing ranges were used, from 40 g for the lowest weights (e.g., 410-450 g) to 840 g for the highest weights (e.g., 3660-4500 g). Medications were divided into 3 categories of administration routes: oral (n = 4), intermittent intravenous (n = 64), and other (e.g., intramuscular; n=6). A significant majority of standardized doses (84%) were within 15% of their corresponding weight-calculated dose. CONCLUSIONS Establishment of a portfolio of standardized, rounded doses of medications commonly used in the NICU was feasibly established by a multi-institutional peer review process, with the great majority of standardized doses being within clinically acceptable ranges of administration. Use of standardized, rounded doses for reduction in dosing errors may be feasible on a systematic level.
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Affiliation(s)
- Christine A Robinson
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey ; Morristown Medical Center, Morristown, New Jersey
| | - Anita Siu
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey ; Jersey Shore University Medical Center, Neptune, New Jersey
| | - Rachel Meyers
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey ; Saint Barnabas Medical Center, Livingston, New Jersey
| | - Ben H Lee
- Morristown Medical Center, Morristown, New Jersey
| | - Jared Cash
- Primary Children's Hospital (Intermountain Healthcare), Salt Lake City, Utah
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Roueché A, Runnacles J. Improving care for the deteriorating child. Arch Dis Child Educ Pract Ed 2014; 99:61-6. [PMID: 24219877 DOI: 10.1136/archdischild-2013-304326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alice Roueché
- Department of Paediatrics, Royal Alexandra Children's Hospital, , Brighton, UK
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Mason JJ, Roberts-Turner R, Amendola V, Sill AM, Hinds PS. Patient safety, error reduction, and pediatric nurses' perceptions of smart pump technology. J Pediatr Nurs 2014; 29:143-51. [PMID: 24707548 DOI: 10.1016/j.pedn.2013.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patient safety and error reduction are essential to improve patient care, and new technology is expected to contribute to such improvements while reducing costs and increasing care efficiency in health care organizations. The purpose of this study was to assess the relationships among pediatric nurses' perceptions of smart infusion pump (SIP) technology, patient safety, and error reduction. Findings revealed that RNs' perceptions of SIP correlated with patient safety. No significant relationship was found between RNs' perceptions of SIP and error reduction, but data retrieved from the pumps revealed 93 manipulations of the pumps, of which error reduction was captured 65 times.
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Patient Safety in Pediatrics. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital- and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases.
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49
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McCaskey MS. Transferring central line care evidence into practice on pediatric acute care units. J Pediatr Nurs 2013; 28:e57-63. [PMID: 23531465 DOI: 10.1016/j.pedn.2013.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 02/05/2013] [Accepted: 02/21/2013] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to examine the effectiveness of an educational intervention to implement evidence based guidelines for central line care. Full-time nurses working on pediatric inpatient units were surveyed before and after the multi-component educational intervention directed at implementation of the central line care bundle. There was a statistically significant increase in the nurses' self-reported compliance with components of the care bundle 6 months after the educational intervention (p<.001), thus improving central line care and infection prevention.
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50
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DeCamp LR, Kuo DZ, Flores G, O'Connor K, Minkovitz CS. Changes in language services use by US pediatricians. Pediatrics 2013; 132:e396-406. [PMID: 23837185 PMCID: PMC8194460 DOI: 10.1542/peds.2012-2909] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Access to appropriate language services is critical for ensuring patient safety and reducing the impact of language barriers. This study compared language services use by US pediatricians in 2004 and 2010 and examined variation in use in 2010 by pediatrician, practice, and state characteristics. METHODS We used data from 2 national surveys of pediatricians (2004: n = 698; 2010: n = 683). Analysis was limited to postresidency pediatricians with patients with limited English proficiency (LEP). Pediatricians reported use of ≥ 1 communication methods with LEP patients: bilingual family member, staff, physician, formal interpreter (professional, telephone), and primary-language written materials. Bivariate analyses examined 2004 to 2010 changes in methods used, and 2010 use by characteristics of pediatricians (age, sex, ethnicity), practices (type, location, patient demographics), and states (LEP population, Latino population growth, Medicaid/Children's Health Insurance Program language services reimbursement). Multivariate logistic regression was performed to determine adjusted odds of use of each method. RESULTS Most pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P < .01). A higher percentage of pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P < .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P < .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24-4.40). CONCLUSIONS US pediatricians' use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use.
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Affiliation(s)
- Lisa Ross DeCamp
- Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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