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Arab R, Cornu C, Kilo R, Portefaix A, Fretes-Bonett B, Hergibo F, Kassai B, Nguyen KA. Trigger tools to identify adverse drug events in hospitalised children: A systematic review. Therapie 2022; 77:527-539. [DOI: 10.1016/j.therap.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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Impact of Computerized Provider Order Entry on Chemotherapy Medication Errors: A Systematic Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-120300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were read repeatedly and related papers were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author’s name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was, then, assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new errors. The rigorous analysis of the chemotherapy process and considering the designing principles could help develop the CPOE systems and minimize ME.
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Alghamdi AA, Keers RN, Sutherland A, Hann M, Gray J, Mason G, Isaac RE, Ashcroft DM. Incidence and nature of adverse drug events in paediatric intensive care units: A prospective multicentre study. Br J Clin Pharmacol 2021; 88:2213-2222. [PMID: 34878686 DOI: 10.1111/bcp.15150] [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: 06/14/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of this study was to assess the incidence, nature, preventability and severity of adverse drug events (ADEs) across three paediatric intensive care units (PICUs) in England. METHODS A prospective observational cohort study was conducted across three PICUs over a three-month period during 2019. Included patients were aged ≤18 years and stayed in PICU for a minimum of 24 hours. Identification of suspected ADEs was performed by trained PICU pharmacists. A multidisciplinary expert panel assessed causality, preventability and severity of events. RESULTS A total of 302 patients were included and 62 ADEs were confirmed (definite/probable causality). One in six patients experienced one or more ADEs. The estimated incidence of ADEs were 20.5 per 100 patients (95% CI 15.3-27.5) and 16.7 per 1000 patient-days (95% CI 9.3-29.9). The majority of ADEs were judged preventable by the expert panel (36/62, 58.1%). ADEs were commonly involved with medicines prescribing (29/62, 46.8%) and caused temporary patient harm (42/62, 67.7%). Medications for the central nervous system (14/62, 22.6%), infections (13/62, 20.9%) and cardiovascular system (12/62, 19.4%) were commonly implicated with ADEs. Multivariable analysis revealed that patients who stayed in PICU for ≥7 days (OR 6.29, 95% CI 2.42-16.32) were more likely to experience an ADE compared to patients with a stay of 1-6 days. CONCLUSION ADEs are common in English PICUs and most of them may be preventable. There is a strong association between ADE occurrence and duration of PICU stay, which represents a target for remedial interventions. Exploring contributory factors of preventable ADEs is now necessary to inform preventive policies.
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Affiliation(s)
- Anwar A Alghamdi
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Health Information Technology Department, Faculty of Applied Studies, King Abdul Aziz University, Jeddah, Kingdom of Saudi Arabia
| | - Richard N Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Medicines Management Team, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, UK
| | - Adam Sutherland
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Pharmacy Department, Royal Manchester Children's Hospital, Manchester, UK
| | - Mark Hann
- Biostatistics Group at University of Manchester, Manchester, UK
| | - Jennifer Gray
- Pharmacy Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Graham Mason
- Paediatric Critical Care, Royal Manchester Children's Hospital, Manchester, UK
| | - Rhian E Isaac
- Pharmacy Department, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, UK
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Caetano SCRDC, Silva LFED, Guaraldo L, Giordani F. Identifying adverse drug events in patients at a pediatric ward in a Brazilian hospital: application and performance of the triggers. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000400007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to evaluate the performance of a trigger tool in identifying adverse drug events (ADE) in hospitalized children. Methods: a retrospective cohort study review on 133 medical records at a federal maternal and child reference hospital in Rio de Janeiro in 2016. A list of 14 triggers was developed to detect ADE in the pediatric population. Three steps were performed: (1) search for triggers; (2) selection of suspected cases of ADE and (3) final determination of ADE by experts’ consensus. Results: 360 triggers were identified in 100 hospitalizations (75.2%), with an average of 2.7 triggers/ hospitalization. The most frequent triggers were “abrupt medication stop” (79.7%); “antiemetics use” (8.9%) and “laxatives use” (7.2%); while the “diphenhydramine use”, “phytomenadione use” and “excessive sedation/lethargy/fall/hypotension” obtained the highest performance indicating ADE every time they occurred. Thirty-one ADE were identified in 12.8% of the hospitalizations; 11 (35.5%) ADE were detected without the aid of the triggers thus, pruritus and diarrhea were the most frequent. Conclusion: the trigger tool proved to be useful in identifying ADE in hospitalized children, especially if high performance and high frequency triggers are used in identifying the events. The inclusion of the triggers “diarrhea” and “pruritus”, may favor the identification of ADE in patients at pediatric wards.
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Leiner M, Peinado J, Baylon A, Lopez I, Pathak I. Divide and conquer: improving parental understanding of health-related instructions using sequential pictorial instructions. HEALTH EDUCATION RESEARCH 2018; 33:104-113. [PMID: 29579193 DOI: 10.1093/her/cyy004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
Patient misunderstandings of healthcare-related instructions result in significant health, social and economic consequences. Pushing the boundaries of traditional academic methods may offer strategies that promote new ways to improve communication and understanding between healthcare providers, caregivers and patients. Comics can be an educational tool, offering an innovative strategy to communicate health-related information. Our study objective was to compare parents' understanding of health-related instructions (i.e. prescription labels, medical instructions and emergency situation scenarios) that were presented using two different formats-sequential pictorial instructions (SPIs) versus written text instructions (WRIs).This was a cross-sectional study to compare parents' understanding of health-related instructions for pediatric patients using structured SPIs versus WRIs. Parents (n = 359, 18-82 years old) of pediatric patients were given a card with instructions that were presented as SPIs (n = 195, 54.3%) or WRIs (n = 164, 45.7%), and then they completed a questionnaire. Total (14 questions) and grouped scores (10 questions) for parental comprehension of prescription and medical emergency instructions were significantly higher among participants viewing the SPIs than those viewing the WRIs in both English and Spanish. The mean understanding of instructions significantly increased from 6% to 12.2% when comparing the WRI versus the SPI.Our initial findings indicate that parents and caregivers of pediatric patients had significantly better understanding and recall of instructions delivered using SPIs than using WRIs.
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Affiliation(s)
- Marie Leiner
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Jesus Peinado
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Angelica Baylon
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Isis Lopez
- Paul Foster School of Medicine, El Paso, TX 79905, USA
| | - Indu Pathak
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
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Nguyen MNR, Mosel C, Grzeskowiak LE. Interventions to reduce medication errors in neonatal care: a systematic review. Ther Adv Drug Saf 2017; 9:123-155. [PMID: 29387337 DOI: 10.1177/2042098617748868] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/27/2017] [Indexed: 01/18/2023] Open
Abstract
Background Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. Methods A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and reference-list checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. Results A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology (n = 38; e.g. electronic prescribing), organizational (n = 16; e.g. guidelines, policies, and procedures), personnel (n = 13; e.g. staff education), pharmacy (n = 9; e.g. clinical pharmacy service), hazard and risk analysis (n = 8; e.g. error detection tools), and multifactorial (n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50-70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. Conclusion While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.
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Affiliation(s)
| | - Cassandra Mosel
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Level 6, AHMS, Adelaide, SA 5000, Australia
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Wegner W, Silva MUMD, Peres MDA, Bandeira LE, Frantz E, Botene DZDA, Predebon CM. Patient safety in the care of hospitalised children: evidence for paediatric nursing. ACTA ACUST UNITED AC 2017; 38:e68020. [PMID: 28492813 DOI: 10.1590/1983-1447.2017.01.68020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/11/2017] [Indexed: 12/28/2022]
Abstract
Objectives To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing. Method An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care. Results Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents. Conclusion General information available on patient safety should be incorporated in paediatric nursing care.
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Affiliation(s)
- Wiliam Wegner
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Merianny de Avila Peres
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Larissa Edom Bandeira
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Elemara Frantz
- Centro Universitário Metodista IPA, Curso de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Caroline Maier Predebon
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
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Weiss BD, Scott M, Demmel K, Kotagal UR, Perentesis JP, Walsh KE. Significant and Sustained Reduction in Chemotherapy Errors Through Improvement Science. J Oncol Pract 2017; 13:e329-e336. [PMID: 28260404 DOI: 10.1200/jop.2017.020842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A majority of children with cancer are now cured with highly complex chemotherapy regimens incorporating multiple drugs and demanding monitoring schedules. The risk for error is high, and errors can occur at any stage in the process, from order generation to pharmacy formulation to bedside drug administration. Our objective was to describe a program to eliminate errors in chemotherapy use among children. METHODS To increase reporting of chemotherapy errors, we supplemented the hospital reporting system with a new chemotherapy near-miss reporting system. After the model for improvement, we then implemented several interventions, including a daily chemotherapy huddle, improvements to the preparation and delivery of intravenous therapy, headphones for clinicians ordering chemotherapy, and standards for chemotherapy administration throughout the hospital. RESULTS Twenty-two months into the project, we saw a centerline shift in our U chart of chemotherapy errors that reached the patient from a baseline rate of 3.8 to 1.9 per 1,000 doses. This shift has been sustained for > 4 years. In Poisson regression analyses, we found an initial increase in error rates, followed by a significant decline in errors after 16 months of improvement work ( P < .001). CONCLUSION After the model for improvement, our improvement efforts were associated with significant reductions in chemotherapy errors that reached the patient. Key drivers for our success included error vigilance through a huddle, standardization, and minimization of interruptions during ordering.
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Affiliation(s)
- Brian D Weiss
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Melissa Scott
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kathleen Demmel
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Uma R Kotagal
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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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
The calculation of dosages in paediatrics is the concern of the whole medical and paramedical team. This activity must generate a minimum of risks in order to prevent care-related adverse events. In this context, the calculation of dosages is a practice which must be understood by everyone.
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Affiliation(s)
- Daniel Benlahouès
- ED 180, Laboratoire Éducation, Discours et apprentissages, Université Paris Descartes, Sorbonne Paris Cité, Faculté des Sciences humaines et sociales, 45 rue des Saints-Pères, 75006 Paris, France.
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Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
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Preventing iatrogenic overdose: a review of in-emergency department opioid-related adverse drug events and medication errors. Ann Emerg Med 2014; 65:423-31. [PMID: 25534653 DOI: 10.1016/j.annemergmed.2014.11.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/06/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE We describe characteristics of patients with in-emergency department (ED) opioid-related adverse drug events, medication errors, and harm resulting from medication errors; identify patient-, provider-, and system-based factors associated with in-ED opioid-related medication errors and harm; and create a list of strategies to prevent future events. METHODS This retrospective study was conducted at 2 urban academic EDs. Potential iatrogenic opioid overdoses were identified by querying the ED electronic medical record for cases when naloxone was administered after an opioid was administered in the ED. Cases involving medication errors resulting in harm were reviewed qualitatively for common patient-, provider-, and systems-based factors that might have contributed to the event. RESULTS Of 73 ED patients with in-ED opioid-related adverse events that required reversal with naloxone, 43 had a medication error resulting in harm. Patient-, provider-, and systems-based factors that might have contributed to the events included chronic health conditions that could predispose an individual to an opioid-related adverse event, failure to adjust opioid dosing in the elderly and for hepatic or renal impairment, multiple doses and routes of administration of opioids, coadministration of opioids with other sedating medications, and systems-based problems with patient handoffs and pharmacy oversight. CONCLUSION We identified patient-, provider-, and systems-based factors related to opioid-related adverse drug events and medication errors among ED patients who had received naloxone. The results from our assessment can be used to inform educational and policy initiatives aimed to prevent in-ED opioid-related adverse drug events and medication errors.
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Schiek S, Hildebrand C, Ranft D, Dürrbeck A, Ghanem M, von Salis-Soglio G, Frontini R, Bertsche T. A cohort study investigating medication management by pharmacists to prevent drug-related problems in pain therapy. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2014-000562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Influence of a systems-based approach to prescribing errors in a pediatric resident clinic. Acad Pediatr 2014; 14:485-90. [PMID: 25169160 DOI: 10.1016/j.acap.2014.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/24/2014] [Accepted: 03/31/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To measure the difference in prescribing error rates between 2 clinics, 1 with a system in place to reduce errors and 1 with no such system; to determine variables that affect the likelihood of prescription errors. METHODS This was a retrospective study at 2 university-based general pediatric clinics utilizing the same electronic medical record (EMR) system. Clinic 1 employed pharmacists who provided daily prescription review, provider feedback and education, and EMR customization to decrease errors. Clinic 2 had no systems in place for reducing prescribing errors. Prescriptions written by resident physicians over 2 months were identified and reviewed. RESULTS A total of 1361 prescriptions were reviewed, 40.7% from clinic 1 and 59.3% from clinic 2. Errors were found in 201 prescriptions (14.8%). Clinics 1 and 2 had error rates of 11% and 17.5%, respectively (P = .0012). The odds of a prescription error at clinic 2 were 1.7 times the odds of a prescription error at clinic 1. Logistic regression identified clinic, nonpediatric resident, liquid dose forms, and younger patient age as significant predictors of prescription errors. Half of the errors could have been prevented with consistent use of a custom medication list within the EMR. CONCLUSIONS We found 37% fewer prescribing errors in a clinic with systems in place for prescribing error detection and prevention. Pediatric clinics should explore systematic procedures for identifying, resolving, and providing education about prescribing errors to reduce patient risk.
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Smyth RL, Peak M, Turner MA, Nunn AJ, Williamson PR, Young B, Arnott J, Bellis JR, Bird KA, Bracken LE, Conroy EJ, Cresswell L, Duncan JC, Gallagher RM, Gargon E, Hesselgreaves H, Kirkham JJ, Mannix H, Smyth RMD, Thiesen S, Pirmohamed M. ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AimsTo comprehensively investigate the incidence, nature and risk factors of adverse drug reactions (ADRs) in a hospital-based population of children, with rigorous assessment of causality, severity and avoidability, and to assess the consequent impact on children and families. We aimed to improve the assessment of ADRs by development of new tools to assess causality and avoidability, and to minimise the impact on families by developing better strategies for communication.Review methodsTwo prospective observational studies, each over 1 year, were conducted to assess ADRs in children associated with admission to hospital, and those occurring in children who were in hospital for longer than 48 hours. We conducted a comprehensive systematic review of ADRs in children. We used the findings from these studies to develop and validate tools to assess causality and avoidability of ADRs, and conducted interviews with parents and children who had experienced ADRs, using these findings to develop a leaflet for parents to inform a communication strategy about ADRs.ResultsThe estimated incidence of ADRs detected in children on admission to hospital was 2.9% [95% confidence interval (CI) 2.5% to 3.3%]. Of the reactions, 22.1% (95% CI 17% to 28%) were either definitely or possibly avoidable. Prescriptions originating in the community accounted for 44 out of 249 (17.7%) of ADRs, the remainder originating from hospital. A total of 120 out of 249 (48.2%) reactions resulted from treatment for malignancies. Off-label and/or unlicensed (OLUL) medicines were more likely to be implicated in an ADR than authorised medicines [relative risk (RR) 1.67, 95% CI 1.38 to 2.02;p < 0.001]. When medicines used for the treatment of oncology patients were excluded, OLUL medicines were not more likely to be implicated in an ADR than authorised medicines (RR 1.03, 95% CI 0.72 to 1.48;p = 0.830). For children who had been in hospital for > 48 hours, the overall incidence of definite and probable ADRs based on all admissions was 15.9% (95% CI 15.0 to 16.8). Opiate analgesic drugs and drugs used in general anaesthesia (GA) accounted for > 50% of all drugs implicated in ADRs. The odds ratio of an OLUL drug being implicated in an ADR compared with an authorised drug was 2.25 (95% CI 1.95 to 2.59;p < 0.001). Risk factors identified were exposure to a GA, age, oncology treatment and number of medicines. The systematic review estimated that the incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children [pooled estimate of 2.9% (95% CI 2.6% to 3.1%)] and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. New tools to assess causality and avoidability of ADRs have been developed and validated. Many parents described being dissatisfied with clinician communication about ADRs, whereas parents of children with cancer emphasised confidence in clinician management of ADRs and the way clinicians communicated about medicines. The accounts of children and young people largely reflected parents’ accounts. Clinicians described using all of the features of communication that parents wanted to see, but made active decisions about when and what to communicate to families about suspected ADRs, which meant that communication may not always match families’ needs and expectations. We developed a leaflet to assist clinicians in communicating ADRs to parents.ConclusionThe Adverse Drug Reactions In Children (ADRIC) programme has provided the most comprehensive assessment, to date, of the size and nature of ADRs in children presenting to, and cared for in, hospital, and the outputs that have resulted will improve the management and understanding of ADRs in children and adults within the NHS. Recommendations for future research: assess the values that parents and children place on the use of different medicines and the risks that they will find acceptable within these contexts; focusing on high-risk drugs identified in ADRIC, determine the optimum drug dose for children through the development of a gold standard practice for the extrapolation of adult drug doses, alongside targeted pharmacokinetic/pharmacodynamic studies; assess the research and clinical applications of the Liverpool Causality Assessment Tool and the Liverpool Avoidability Assessment Tool; evaluate, in more detail, morbidities associated with anaesthesia and surgery in children, including follow-up in the community and in the home setting and an assessment of the most appropriate treatment regimens to prevent pain, vomiting and other postoperative complications; further evaluate strategies for communication with families, children and young people about ADRs; and quantify ADRs in other settings, for example critical care and neonatology.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Rosalind L Smyth
- Institute of Child Health, University of Liverpool, Liverpool, UK
- Institute of Child Health, University College London, London, UK
| | - Matthew Peak
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Mark A Turner
- Institute of Translational Medicine, Liverpool Women’s National Health Service Foundation Trust and University of Liverpool, Liverpool, UK
| | - Anthony J Nunn
- National Institute for Health Research Medicines for Children Research Network, University of Liverpool, Liverpool, UK
| | | | - Bridget Young
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Janine Arnott
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jennifer R Bellis
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Kim A Bird
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Louise E Bracken
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | | | - Lynne Cresswell
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Jennifer C Duncan
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | | | - Elizabeth Gargon
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Hannah Hesselgreaves
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helena Mannix
- Alder Hey Children’s National Health Service Foundation Trust, Liverpool, UK
| | - Rebecca MD Smyth
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Signe Thiesen
- Institute of Child Health, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Sakuma M, Ida H, Nakamura T, Ohta Y, Yamamoto K, Seki S, Hiroi K, Kikuchi K, Nakayama K, Bates DW, Morimoto T. Adverse drug events and medication errors in Japanese paediatric inpatients: a retrospective cohort study. BMJ Qual Saf 2014; 23:830-7. [PMID: 24742779 DOI: 10.1136/bmjqs-2013-002658] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Knowledge about the epidemiology of adverse drug events (ADEs) and medication errors in paediatric inpatients is limited outside Western countries. To improve paediatric patient safety worldwide, assessing local epidemiology is essential. DESIGN The Japan Adverse Drug Events (JADE) Study was a cohort study. SETTING Paediatric inpatients at two tertiary care teaching hospitals in Japan. MAIN OUTCOME MEASURES ADEs and medication errors identified by onsite review of all medical charts, incident reports and prescription queries by pharmacists. Two independent physicians reviewed all incidents and classified ADEs and medication errors, as well as their severity and preventability. RESULTS We enrolled 1189 admissions which included 12,691 patient-days during the study period, and identified 480 ADEs and 826 medication errors. The incidence of ADEs was 37.8 (95% CI 34.4 to 41.2) per 1000 patient-days and that of medication errors was 65.1 (95% CI 60.6 to 69.5) per 1000 patient-days. Among ADEs, 4%, 23% and 73% were fatal or life-threatening, serious and significant, respectively. Among the 480 ADEs, 36 (8%) were considered to be preventable which accounted for 4% of all medication errors, while 668 (81%) of all medication errors were judged to have the potential to cause harm to patients. The most common error stage for preventable ADEs was monitoring (78%) whereas 95% of potential ADEs occurred at the ordering stage. CONCLUSIONS ADEs and medication errors were common in paediatric inpatients in Japan, though the proportion of ADEs that were preventable was low. The ordering and monitoring stages appeared most important for improving safety.
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Affiliation(s)
- Mio Sakuma
- Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroyuki Ida
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | | | - Yoshinori Ohta
- Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kaori Yamamoto
- Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Susumu Seki
- Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kayoko Hiroi
- Women's and Children's Medical Center, Jikei University Hospital, Tokyo, Japan
| | | | - Kengo Nakayama
- Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Takeshi Morimoto
- Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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18
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Manias E. Detection of medication-related problems in hospital practice: a review. Br J Clin Pharmacol 2014. [PMID: 23194349 DOI: 10.1111/bcp.12049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This review examines the effectiveness of detection methods in terms of their ability to identify and accurately determine medication-related problems in hospitals. A search was conducted of databases from inception to June 2012. The following keywords were used in combination: medication error or adverse drug event or adverse drug reaction, comparison, detection, hospital and method. Seven detection methods were considered: chart review, claims data review, computer monitoring, direct care observation, interviews, prospective data collection and incident reporting. Forty relevant studies were located. Detection methods that were better able to identify medication-related problems compared with other methods tested in the same study included chart review, computer monitoring, direct care observation and prospective data collection. However, only small numbers of studies were involved in comparisons with direct care observation (n = 5) and prospective data collection (n = 6). There was little focus on detecting medication-related problems during various stages of the medication process, and comparisons associated with the seriousness of medication-related problems were examined in 19 studies. Only 17 studies involved appropriate comparisons with a gold standard, which provided details about sensitivities and specificities. In view of the relatively low identification of medication-related problems with incident reporting, use of this method in tracking trends over time should be met with some scepticism. Greater attention should be placed on combining methods, such as chart review and computer monitoring in examining trends. More research is needed on the use of claims data, direct care observation, interviews and prospective data collection as detection methods.
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Affiliation(s)
- Elizabeth Manias
- Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia.
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19
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Watts RG, Parsons K. Chemotherapy medication errors in a pediatric cancer treatment center: prospective characterization of error types and frequency and development of a quality improvement initiative to lower the error rate. Pediatr Blood Cancer 2013; 60:1320-4. [PMID: 23519908 DOI: 10.1002/pbc.24514] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 02/05/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chemotherapy medication errors occur in all cancer treatment programs. Such errors have potential severe consequences: either enhanced toxicity or impaired disease control. Understanding and limiting chemotherapy errors are imperative. PROCEDURE A multi-disciplinary team developed and implemented a prospective pharmacy surveillance system of chemotherapy prescribing and administration errors from 2008 to 2011 at a Children's Oncology Group-affiliated, pediatric cancer treatment program. Every chemotherapy order was prospectively reviewed for errors at the time of order submission. All chemotherapy errors were graded using standard error severity codes. Error rates were calculated by number of patient encounters and chemotherapy doses dispensed. Process improvement was utilized to develop techniques to minimize errors with a goal of zero errors reaching the patient. RESULTS Over the duration of the study, more than 20,000 chemotherapy orders were reviewed. Error rates were low (6/1,000 patient encounters and 3.9/1,000 medications dispensed) at the start of the project and reduced by 50% to 3/1,000 patient encounters and 1.8/1,000 medications dispensed during the initiative. Error types included chemotherapy dosing or prescribing errors (42% of errors), treatment roadmap errors (26%), supportive care errors (15%), timing errors (12%), and pharmacy dispensing errors (4%). Ninety-two percent of errors were intercepted before reaching the patient. No error caused identified patient harm. Efforts to lower rates were successful but have not succeeded in preventing all errors. CONCLUSIONS Chemotherapy medication errors are possibly unavoidable, but can be minimized by thoughtful, multispecialty review of current policies and procedures. Pediatr Blood Cancer 2013;601320-1324. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Raymond G Watts
- Division of Pediatric Hematology-Oncology, University of Alabama, Birmingham, Alabama 35233, USA
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20
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Du W, Tutag Lehr V, Caverly M, Kelm L, Reeves J, Lieh-Lai M. Incidence and Costs of Adverse Drug Reactions in a Tertiary Care Pediatric Intensive Care Unit. J Clin Pharmacol 2013; 53:567-73. [DOI: 10.1002/jcph.75] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/14/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Wei Du
- Department of Pediatrics, School of Medicine; Wayne State University; Detroit, MI; USA
| | - Victoria Tutag Lehr
- Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences; Wayne State University; Detroit, MI; USA
| | - Mary Caverly
- Critical Care Medicine; Children's Hospital of Michigan; Detroit, MI; USA
| | - Lauren Kelm
- Critical Care Medicine; Children's Hospital of Michigan; Detroit, MI; USA
| | - Jaxk Reeves
- Department of Statistics; University of Georgia; Athens, GA; USA
| | - Mary Lieh-Lai
- Department of Pediatrics, School of Medicine; Wayne State University; Detroit, MI; USA
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21
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Nwulu U, Nirantharakumar K, Odesanya R, McDowell SE, Coleman JJ. Improvement in the detection of adverse drug events by the use of electronic health and prescription records: an evaluation of two trigger tools. Eur J Clin Pharmacol 2012; 69:255-9. [PMID: 22706621 DOI: 10.1007/s00228-012-1327-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To test if two of the adverse event triggers proposed by the Institute of Healthcare Improvement can detect adverse drug events (ADEs) in a UK secondary care setting, using an electronic prescribing and health record system. METHODS In order to identify triggers for over-anticoagulation and potential opioid overdose and we undertook a retrospective review of electronic medical and prescription records from 54,244 hospital admissions over a 1-year period, alongside a review of medical incident reports. Once prescription data were linked to triggers and duplicates were removed, case note review eliminated the false positive ADEs. Additionally, we tested the use of an electronic algorithm for the International Normalized Ratio (INR) ≥6 trigger. RESULTS The INR ≥6 electronic trigger identified 46 potential ADEs and the naloxone electronic trigger identified 82 ADEs. Based on the available case note review, the INR ≥6 trigger had a positive predictive value (PPV) of 38 % (14/37) and the naloxone trigger had a PPV of 91 % (61/67). The electronic algorithm for the INR ≥6 trigger identified 12 ADEs, thus reducing the need of case note review. This was in comparison with one and two critical incidents reported in the trust medical incident reports system, which respectively related to over-coagulation with warfarin and over-sedation with opioid medication. CONCLUSIONS We have integrated automated and manual methods of detecting ADEs using previously defined triggers. Incorporating electronic triggers in already established electronic health records with prescription and laboratory test data can improve the detection of ADEs, and potentially lead to methods to avert them.
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Affiliation(s)
- Ugochi Nwulu
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
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22
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Pintor-Mármol A, Baena MI, Fajardo PC, Sabater-Hernández D, Sáez-Benito L, García-Cárdenas MV, Fikri-Benbrahim N, Azpilicueta I, Faus MJ. Terms used in patient safety related to medication: a literature review. Pharmacoepidemiol Drug Saf 2012; 21:799-809. [PMID: 22678709 DOI: 10.1002/pds.3296] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 04/22/2012] [Accepted: 04/26/2012] [Indexed: 11/07/2022]
Abstract
PURPOSE There is a lack of homogeneity in the terminology used in the context of patient safety related to medication. The aim of this review was to identify the terms and definitions used in patient safety related to medication within the scientific literature. METHODS Original and review articles that were indexed between 1998 and 2008 in MEDLINE and EMBASE and contained terms used in patient safety related to medication were included. Terms and definitions were extracted and categorised according to whether its definition referred to the process of medication use, or to the clinical outcome of medication use, or both. RESULTS Of 2564 articles, 147 were included. Sixty terms used in patient safety related to medication with 189 different definitions were identified. Among terms that referred only to the process of medication use (n = 23), medication error provided the greatest number of definitions (n = 29). Among terms that referred only to the clinical outcome of medication use (n = 31), adverse drug event provided the greatest number of definitions (n = 15). Finally, among terms that referred both to the process of use and to the clinical outcome of medication use (n = 13), drug-related problem provided the greatest number of definitions (n = 7). CONCLUSIONS A multitude of terms and definitions are used in patient safety related to medication. This heterogeneity makes it difficult to compare the results among studies and to appreciate the true magnitude of the problem. Classifying and unifying the terminology is necessary to advance in patient safety strategies.
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Smyth RMD, Gargon E, Kirkham J, Cresswell L, Golder S, Smyth R, Williamson P. Adverse drug reactions in children--a systematic review. PLoS One 2012; 7:e24061. [PMID: 22403604 PMCID: PMC3293884 DOI: 10.1371/journal.pone.0024061] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 07/30/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adverse drug reactions in children are an important public health problem. We have undertaken a systematic review of observational studies in children in three settings: causing admission to hospital, occurring during hospital stay and occurring in the community. We were particularly interested in understanding how ADRs might be better detected, assessed and avoided. METHODS AND FINDINGS We searched nineteen electronic databases using a comprehensive search strategy. In total, 102 studies were included. The primary outcome was any clinical event described as an adverse drug reaction to one or more drugs. Additional information relating to the ADR was collected: associated drug classification; clinical presentation; associated risk factors; methods used for assessing causality, severity, and avoidability. Seventy one percent (72/102) of studies assessed causality, and thirty four percent (34/102) performed a severity assessment. Only nineteen studies (19%) assessed avoidability. Incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children (pooled estimate of 2.9% (2.6%, 3.1%)) and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. Anti-infectives and anti-epileptics were the most frequently reported therapeutic class associated with ADRs in children admitted to hospital (17 studies; 12 studies respectively) and children in hospital (24 studies; 14 studies respectively), while anti-infectives and non-steroidal anti-inflammatory drugs (NSAIDs) were frequently reported as associated with ADRs in outpatient children (13 studies; 6 studies respectively). Fourteen studies reported rates ranging from 7%-98% of ADRs being either definitely/possibly avoidable. CONCLUSIONS There is extensive literature which investigates ADRs in children. Although these studies provide estimates of incidence in different settings and some indication of the therapeutic classes most frequently associated with ADRs, further work is needed to address how such ADRs may be prevented.
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Affiliation(s)
- Rebecca Mary Diane Smyth
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England, United Kingdom.
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24
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Hakkarainen KM, Andersson Sundell K, Petzold M, Hägg S. Methods for Assessing the Preventability of Adverse Drug Events. Drug Saf 2012; 35:105-26. [DOI: 10.2165/11596570-000000000-00000] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
BACKGROUND Considering all sources of errors that may occur during healthcare, medication errors are the most common and also the most frequent cause of adverse events. OBJECTIVE The objective of the study was to describe the medication errors reported in a pediatric intensive care unit for oncologic patients. METHODS This is a descriptive and exploratory study. The errors were reported by the professionals involved in the medication system in a medication error report form developed for the study. RESULTS The sample consisted of 110 medication errors reported on 71 forms. The omission error was the most common error type reported (22.7%), followed by administration error (18.2%). No harm to patients was reported in 83.1% of the notifications. CONCLUSION The analysis of the110 medication errors provides evidence of the context of their occurrence and the need to implement measures that can prevent or intercept these errors. IMPLICATIONS FOR PRACTICE In an institution without adverse events report and a formal system to patient safety analysis, the implementation of a local nonpunitive approach to medication errors notification represented an important tool to patient safety promotion.
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Tham E, Calmes HM, Poppy A, Eliades AB, Schlafly SM, Namtu KC, Smith DM, Vitaska MC, McConnell C, Potts AL, Jastrzembski J, Logsdon TR, Hall M, Takata GS. Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative. Pediatrics 2011; 128:e438-45. [PMID: 21727100 DOI: 10.1542/peds.2010-3772] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Adverse drug events (ADEs) occur more frequently in pediatric patients than adults. ADEs frequently cause serious harm to children and increase the cost of care. The purpose of this study was to decrease ADEs by targeting the entire medication-delivery system for all high-risk medications. METHODS Thirteen freestanding children's hospitals participated in this ADE collaborative. An advisory panel developed a change package of interventions that consisted of standardization of medication-ordering (eg, consensus-based protocols and order sets and high-alert medication protocols), reliable medication-dispensing processes (eg, automated dispensing cabinets and redesign of floor stock procedures), reliable medication-administration processes (eg, safe pump use and reducing interruptions), improvement of patient safety culture (eg, safety-culture changes and reduction of staff intimidation), and clinical decision support (eg, increase ADE detection and redesign care systems). ADE rates were compared from the 3-month baseline period to quarters of the 12-month intervention phase. ADE rates were categorized further as opioid related and other medication related. RESULTS From baseline to the final quarter, the collaborative resulted in a 42% decrease in total ADEs, a 51% decrease in opioid-related ADEs, and a 41% decrease in other medication ADEs. CONCLUSION A pediatric collaborative that targeted the medication-delivery system decreased the rate of ADEs at participating institutions.
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Affiliation(s)
- Eric Tham
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
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Mc Donnell C. Opioid medication errors in pediatric practice: four years' experience of voluntary safety reporting. Pain Res Manag 2011; 16:93-8. [PMID: 21499584 PMCID: PMC3084410 DOI: 10.1155/2011/739359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioids are the most common source of drug error that leads to harm in pediatric hospitals. OBJECTIVE To undertake a comprehensive review of experience with voluntary safety reports describing pediatric opioid medication errors at The Hospital for Sick Children (Toronto, Ontario), and to characterize the specific opioids involved, severity and type of error described, hospital location and time of day that the error occurred. METHODS All medication-related safety reports submitted to an anonymous, voluntary electronic safety reporting database in a university-affiliated pediatric hospital during the first four years of its use were examined. A database of opioid error reports was created for further analysis. RESULTS A total of 5,935 medication-related safety reports were collected, 507 of which described opioids. Morphine was the most frequently reported opioid, administration was the most frequently reported stage of the medication process (192 errors) and surgical wards were the location from which opioid error was most frequently reported (128 reports). Twenty-two reports described patient harm requiring urgent treatment and intervention. Errors with codeine or hydromorphone resulted in the most significant harm reported. A total of 162 reports described problems with inappropriate opioid disposal, missing opioids, or incorrect opioid counts and checks. CONCLUSIONS Future opportunities for improvement in opioid safety should focus on morphine, opioid administration errors in general, the safe disposal of opioids in the hospital environment and the identification of pain as an adverse event.
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Affiliation(s)
- Conor Mc Donnell
- Department of Anesthesia & Pain Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Ontario.
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Meyer-Massetti C, Cheng CM, Schwappach DLB, Paulsen L, Ide B, Meier CR, Guglielmo BJ. Systematic review of medication safety assessment methods. Am J Health Syst Pharm 2011; 68:227-40. [DOI: 10.2146/ajhp100019] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Carla Meyer-Massetti
- Medication Safety And Drug Event Monitoring, Swiss Patient Safety Foundation (SPSF), Zurich, Switzerland, and Junior Specialist, Medication Outcomes Center, Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco (UCSF), San Francisco
| | - Christine M. Cheng
- Medication Outcomes Center, Department of Clinical Pharmacy, School of Pharmacy, UCSF
| | - David L. B. Schwappach
- Division of Social and Behavioral Health Research, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Brigid Ide
- Patient Safety and Quality Services, UCSF Medical Center
| | - Christoph R. Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland, and Director of Pharmaceutical Services, Hospital Pharmacy, University Hospital Basel, Basel
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Silva MDDG, Rosa MB, Franklin BD, Reis AMM, Anchieta LM, Mota JAC. Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study. Clinics (Sao Paulo) 2011; 66:1691-7. [PMID: 22012039 PMCID: PMC3180166 DOI: 10.1590/s1807-59322011001000005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/19/2011] [Accepted: 06/19/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6%) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4%) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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