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Philips K, Zhou R, Lee DS, Marrese C, Nazif J, Browne C, Sinnett M, Tuckman S, Modi A, Rinke ML. Implementation of a Standardized Approach to Improve the Pediatric Discharge Medication Process. Pediatrics 2021; 147:peds.2019-2711. [PMID: 33408070 PMCID: PMC7849199 DOI: 10.1542/peds.2019-2711] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The pediatric inpatient discharge medication process is complicated, and caregivers have difficulty managing instructions. Authors of few studies evaluate systematic processes for ensuring quality in these care transitions. We aimed to improve caregiver medication management and understanding of discharge medications by standardizing the discharge medication process. METHODS An interprofessional team at an urban, tertiary care children's hospital trialed interventions to improve caregiver medication management and understanding. These included mnemonics to aid in complete medication counseling, electronic medical record enhancements to standardize medication documentation and simplify dose rounding, and housestaff education. The primary outcome measure was the proportion of discharge medication-related failures in each 4-week period. Failure was defined as an incorrect response on ≥1 survey questions. Statistical process control was used to analyze improvement over time. Process measures related to medication documentation and dose rounding were compared by using the χ2 test and process control. RESULTS Special cause variation occurred in the mean discharge medication-related failure rate, which decreased from 70.1% to 36.1% and was sustained. There were significantly more complete after-visit summaries (21.0% vs 85.1%; P < .001) and more patients with simplified dosing (75.2% vs 95.6%; P < .001) in the intervention period. Special cause variation also occurred for these measures. CONCLUSIONS A systematic approach to standardizing the discharge medication process led to improved caregiver medication management and understanding after pediatric inpatient discharge. These changes could be adapted by other hospitals to enhance the quality of this care transition.
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Affiliation(s)
- Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, New York; .,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Roy Zhou
- NewYork-Presbyterian Queens Hospital, Flushing, New York
| | - Diana S. Lee
- Mount Sinai Kravis Children’s Hospital, New York, New York; and
| | - Christine Marrese
- Baystate Children’s Hospital, Baystate Medical Center, Springfield, Massachusetts
| | - Joanne Nazif
- Children’s Hospital at Montefiore, Bronx, New York;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | | | - Mark Sinnett
- Children’s Hospital at Montefiore, Bronx, New York
| | | | - Anjali Modi
- Children’s Hospital at Montefiore, Bronx, New York
| | - Michael L. Rinke
- Children’s Hospital at Montefiore, Bronx, New York;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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Hoeve CE, de Vries E, Mol PGM, Sturkenboom MCJM, Straus SMJM. Dissemination of Direct Healthcare Professional Communications on Medication Errors for Medicinal Products in the EU: An Explorative Study on Relevant Factors. Drug Saf 2020; 44:73-82. [PMID: 33355904 PMCID: PMC7813691 DOI: 10.1007/s40264-020-00995-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction When serious medication errors (ME) are identified, communication to the field may be necessary. In the EU, communication of serious safety issues, such as medication errors associated with adverse drug reactions, is done through direct healthcare professional communications (DHPCs). We aimed to identify how often DHPCs about medication errors are distributed, and we explored factors associated with these ME DHPCs. Methods We performed a descriptive study of all centrally authorised products (CAPs) approved before 1 May 2019 in the EU. All DHPCs issued between 1 January 2001 and 1 May 2019 were reviewed for ME content. Characteristics of CAPs were collected from the website of the European Medicines Agency. A Kaplan–Meier survival analysis was performed to estimate the 5- and 10-year probability of the occurrence of a first ME DHPC. A logistic regression was performed to explore risk factors for ME DHPCs. Results A total of 678 CAPs were included, of which 35 required an ME DHPC during the study period. The 5-year probability for a CAP to have a first ME DHPC was 2.5% (95% CI 1.1–3.9) and the 10-year probability was 4.4% (95% CI 2.2–6.5). Among products with an ME DHPC, the 5-year probability of a second ME DHPC was 21.3% (95% CI 0.2–38.0). The risk of ME DHPCs was increased for products with multiple pharmaceutical formulations, enteral liquid or parenteral injection preparations, and products classified as nervous system agents or antineoplastic and immunomodulating agents. Conclusions The absolute number of ME DHPCs for CAPs is low and does not give rise to immediate concern. We identified potential risk factors for ME DHPCs that should be taken into account during approval procedures or line extensions. Electronic supplementary material The online version of this article (10.1007/s40264-020-00995-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina E Hoeve
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands. .,Medicines Evaluation Board, Utrecht, The Netherlands.
| | - Esther de Vries
- Medicines Evaluation Board, Utrecht, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - Peter G M Mol
- Medicines Evaluation Board, Utrecht, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sabine M J M Straus
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
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Nguyen TT, Bergeron E, Lewis TV, Miller JL, Hagemann TM, Neely S, Johnson PN. Descriptive study of discharge medications in pediatric patients. SAGE Open Med 2020; 8:2050312120927945. [PMID: 32547752 PMCID: PMC7271562 DOI: 10.1177/2050312120927945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Limited studies have evaluated medications in children discharged from
hospitals. Knowledge of the number of medications and dosage forms could
provide a baseline to establish a medication discharge prescription
program. Objectives: To identify the median number of discharge prescriptions per patient.
Secondary objectives included an evaluation of the dosage formulations and
frequency, and comparisons of the prevalence of unrounded medication doses
between service type (medical vs surgical) and physician provider level
(trainees vs attendings). Methods: This retrospective study included children <18 years receiving
>1 discharge prescription during 4 selected
months over a 1-year time frame. Comparisons were made via Pearson’s
chi-square tests, Fisher’s Exact tests, and Kruskal–Wallis nonparametric
rank tests as appropriate with a priori p value of
<0.05. Results: A total of 852 patients were evaluated, with most (78.8%) on a medical
service. The median (interquartile range) number of new medications at
discharge was 2 (1–3), with the median total number of discharge medications
of 3 (2–6). There was no difference in the net change of the median number
of home medications stopped and new medications started between service
types. The majority (72.2%) received >1 oral
liquid medications. There was no difference in prescribing rates per service
type and provider level. There was a difference in the number of unrounded
doses between trainees versus attendings, 17.8% versus 9.5%,
p = 0.048. Conclusion: Patients were discharged on a median of three medications, and most received
>1 oral liquid medications. These data can be
used to target children who would benefit from medication discharge
prescription programs.
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Affiliation(s)
- Thao T Nguyen
- The Children’s Hospital at Saint
Francis, Tulsa, OK, USA
| | - Erica Bergeron
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | - Teresa V Lewis
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | - Jamie L Miller
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | | | - Stephen Neely
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | - Peter N Johnson
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
- Peter N Johnson, Department of Pharmacy:
Clinical and Administrative Sciences, The University of Oklahoma College of
Pharmacy, O’Donoghue Research Building, Suite ODON4415, 1122 Northeast 13th
Street, Oklahoma City, OK 73117, USA.
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Philips K, Zhou R, Lee DS, Marrese C, Nazif J, Browne C, Sinnett M, Tuckman S, Griffith K, Kiely V, Lutz M, Modi A, Rinke ML. Caregiver Medication Management and Understanding After Pediatric Hospital Discharge. Hosp Pediatr 2019; 9:844-850. [PMID: 31582401 PMCID: PMC6818354 DOI: 10.1542/hpeds.2019-0036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. METHODS This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. RESULTS Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P = .03). CONCLUSIONS The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.
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Affiliation(s)
- Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, New York;
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | - Roy Zhou
- Children's Hospital at Montefiore, Bronx, New York
| | - Diana S Lee
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Joanne Nazif
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Mark Sinnett
- Children's Hospital at Montefiore, Bronx, New York
| | | | | | | | - Marcia Lutz
- Children's Hospital at Montefiore, Bronx, New York
| | - Anjali Modi
- Children's Hospital at Montefiore, Bronx, New York
| | - Michael L Rinke
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
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