Implementing leadership rounds to improve patient safety.
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ABSTRACT: Iatrogenic injuries, including medication errors, are an important problem in all hospitalized populations. However, few epidemiological data are available regarding medication errors in the pediatric inpatient setting. To assess the rates of medication errors, adverse drug events (ADEs), and potential ADEs; to compare pediatric rates with previously reported adult rates; to analyze the major types of errors; and to evaluate the potential impact of prevention strategies. Prospective cohort study of 1120 patients admitted to 2 academic institutions during 6 weeks in April and May of 1999. Medication errors, potential ADEs, and ADEs were identified by clinical staff reports and review of medication order sheets, medication administration records, and patient charts. We reviewed 10 778 medication orders and found 616 medication errors (5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5 (19%) were preventable. While the preventable ADE rate was similar to that of a previous adult hospital study, the potential ADE rate was 3 times higher. The rate of potential ADEs was significantly higher in neonates in the neonatal intensive care unit. Most potential ADEs occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%). Physician reviewers judged that computerized physician order entry could potentially have prevented 93% and ward-based clinical pharmacists 94% of potential ADEs. Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them.JAMA The Journal of the American Medical Association 05/2001; 285(16):2114-20. · 30.39 Impact Factor
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ABSTRACT: Medical errors are an important problem for hospitalized adult inpatients. However, medical errors in children remain comparatively understudied, and published research has been relatively limited. To investigate the national rates of hospital-reported medical errors in pediatric inpatients over the period 1988-1997; and to determine the association of patient and hospital characteristics with the occurrence of hospital-reported medical errors in children. A nonconcurrent cohort study of hospitalized nonnewborn pediatric patients in the United States <or=18 years of age. Data from the Healthcare Cost and Utilization Project for the years 1988, 1991, 1994, and 1997 were used for these analyses. The occurrence of hospital-reported medical errors. The national rate of hospital-reported medical errors in hospitalized children ranged from 1.81 to 2.96 per 100 discharges. These medical error rates were statistically lower in 1988, with the years 1991, 1994, and 1997 not being statistically different from each other. There were no consistent differences in the rates of medical errors when stratified by gender, race, payor status, or median household income of the patient's zip code across years. There was, however, a statistically significant relationship between higher median household income and increasing medical error rates; this trend was consistent across all 4 years. Similarly, children with special medical needs or dependence on a medical technology also had significantly higher rates of hospital-reported medical errors. Although hospital size did not seem to be related to the rate of medical errors, private for-profit hospitals consistently reported lower rates, whereas urban teaching hospitals in all years but 1997 reported higher rates of medical errors. These data highlight both the strengths and limitations of administrative data in the investigation of medical errors. Substantively, they suggest fruitful areas for additional and more detailed study, notably children with special medical needs.PEDIATRICS 04/2003; 111(3):617-21. DOI:10.1542/peds.111.3.617 · 5.30 Impact Factor
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ABSTRACT: Improving patient safety incorporates two complementary approaches. The first, inspired by research in cognitive psychology and the lessons of accident investigation in other industries, provides qualitative methods for anticipating errors, documenting critical incidents, and responding to them in a blame-free and structured manner. Using such qualitative methods, physicians can generate meaningful strategies for preventing similar occurrences in the future. Hospital-based physicians have an important role to play in promoting a culture of safety by championing incident-reporting initiatives and participating in multidisciplinary teams that analyze adverse events and promote change. The second approach involves applying the results of quantitative clinical research to reduce some of the common hazards of hospitalization. Hospitalists also have an important role to play in this arena because many of these safety targets and the associated clinical practices (e.g., early enteral nutritional support and fall prevention) are not on the radar screens of many hospital-based specialists. In both circumstances, physician participation in collaboration with nurses, pharmacists, nutritionists, and other health care professionals would likely produce important improvements in patient care. More important, physician involvement in these initiatives will undoubtedly contribute visible leadership in promoting a culture of patient safety in hospitals and in health care.Medical Clinics of North America 08/2002; 86(4):847-67. DOI:10.1016/S0025-7125(02)00016-0 · 2.80 Impact Factor