Automated Detection of Adverse Events in Children

Center for Pediatric Informatics, Children's National Medical Center, 111 Michigan Avenue, Washington, DC 20010, USA.
Pediatric Clinics of North America (Impact Factor: 2.12). 12/2012; 59(6):1269-78. DOI: 10.1016/j.pcl.2012.08.007
Source: PubMed


Voluntary reporting has been the standard method for identifying adverse events in hospitals, yet its effectiveness at identifying a comprehensive array of adverse events has always been in question. The electronic health record (EHR) contains clinical data that can be systematically reviewed to identify adverse events and improve adverse event detection. Active use of an automated trigger tool that is embedded in an EHR can identify systematic issues with delivery of high-risk medications and is cost-effective and efficient. Further development of an automated adverse event detection protocol for pediatrics is needed to apply this approach systematically across pediatric institutions.

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    • "Quality improvement research involving team approaches to error detection and system change may help us to understand the factors contributing to pediatric medication errors and generate more effective strategies to prevent them. In addition, the automated detection of medication errors with pediatric-specific triggers could assist in improving our knowledge about identifying these events and reducing patient harm.78 "
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    ABSTRACT: Medication errors affect the pediatric age group in all settings: outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies.
    Health Services Insights 06/2013; 6:47-59. DOI:10.4137/HSI.S10454
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    ABSTRACT: Adverse event registration is a means to improve patient safety in a PICU. So far it has been used in European and North American countries mainly. We studied adverse events in a South African setting with the aims to 1) assess rates and types of adverse events with two different registration methods and 2) describe characteristics of patients experiencing adverse events. This study consisted of 1) a retrospective audit of randomly selected patient records and 2) a prospective observational study of real-time registration of AEs during ward rounds. Adverse events were identified using the Child Health Corporation of America - Pediatric Pharmacy Advocacy Group PICU trigger tool. A multidisciplinary 20 bed Pediatric Intensive Care Unit at the Red Cross War Memorial Children's Hospital in Cape Town. The retrospective section of the study involved 80 randomly selected patients who had been discharged from the PICU, and the prospective study involved patients who were present in the PICU between March and June 2012. None. The retrospective audit identified 260 adverse events in 61 patients (50.8 per 100 patient days). Nineteen patients (24%) did not have any adverse events. Catheter complications, hypoglycemia, and endotracheal tube malpositioning requiring repositioning were most frequent. Prospective registration during 58 ward rounds revealed 272 adverse events in 236 patients (27.2 per 100 patient days), particularly catheter complications, nosocomial infection, and surgical complications. Hundred thirty-two patients of the total 236 patients (56%) did not experience an adverse event. Patients experiencing adverse events underwent mechanical ventilation significantly more frequently. Length of stay was significantly associated with number of adverse events. The trigger tool method identifies a higher adverse event rate compared with real-time registration. Each method has a unique contribution to yield types of adverse events.
    Pediatric Critical Care Medicine 04/2014; 15(5). DOI:10.1097/PCC.0000000000000114 · 2.34 Impact Factor
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    ABSTRACT: Objectives The British National Health Service (NHS) Paediatric Trigger Tool (PTT) was made based on various trigger tools developed for use in adults. The PTT has not previously been developed or used in Nordic units. We aimed to compare harm identified through PTT screening with voluntary incidence reports in our department. A secondary aim was to assess utility of the different triggers, including predictive value for identifying harm. We hypothesised that the NHS PTT would need adjustments for the setting in which it is used. Setting A Norwegian level II department of paediatric and adolescent medicine. Participants A convenience sample of 761 acute medical and surgical patient contacts March–May 2011. Median age (IQR) for the trigger positive patients was 2.5 (1.0–8.0) years; range 0–18 years. Primary and secondary outcome measures Incidence, type and severity of harm identified with the PTT compared with the department's voluntary incidence reports. The type and rate of identified triggers and positive predictive value for harm. Results The PTT revealed a harm rate of 5% for medical patients, as compared to 0.5% in the incidence reports the same months. PTT screening revealed other types of harm than those reported by healthcare personnel themselves. We identified only 20 of the 39 NHS PTT triggers. The most frequent trigger was readmission within 30 days. Hypoxia, which was the second most frequent trigger, did not predict any patient harm. Conclusions This study showed that the NHS PTT identifies more and other types of harm than voluntary incidence reports. The presence of adult-oriented triggers, triggers that were not identified at all, as well as triggers with a low predictive value for harm may indicate the need for modification of the PTT to different settings. More studies are needed before a final decision is made to exclude triggers from the screening.
    BMJ Open 05/2014; 4(5):e005011. DOI:10.1136/bmjopen-2014-005011 · 2.27 Impact Factor
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