Article

Risk factors in preventable adverse drug events in pediatric outpatients

Department of Pediatrics, Weill Cornell Medical College and Komansky Center for Children's Health at New York Presbyterian Hospital, New York, New York, USA.
The Journal of pediatrics (Impact Factor: 3.74). 03/2008; 152(2):225-31. DOI: 10.1016/j.jpeds.2007.09.054
Source: PubMed

ABSTRACT To determine whether there are racial/ethnic, socioeconomic, parental linguistic, or parental educational disparities in children who experienced an adverse drug event (ADE) in the ambulatory setting.
We conducted a prospective cohort study of pediatric patients <21 years seen during 2-month study periods from July 2002 to April 2003 at 6 office practices in Boston. The primary outcome measure was ADEs. Descriptive analysis of patient characteristics and types of ADEs experienced was followed by multivariate analysis to determine risk factors associated with presence of a preventable ADE.
A total of 1689 patients receiving 2155 prescriptions were analyzed via a survey and chart review. Overall, 242 children (14%) experienced an ADE, of which 55 (23%) had a preventable ADE and 186 (77%) had a non-preventable ADE. In multivariate analysis, children with multiple prescriptions (odds ratio, 1.46; 95% CI, 1.01-2.11) were at increased risk of having a preventable ADE, controlling for parental education, racial/ethnic, English proficiency, practice type, and duration of care.
Children with multiple prescriptions are at increased risk of having a preventable ADE. Further attention should be directed toward improved communication among healthcare providers and patients.

0 Followers
 · 
116 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Patient safety is a powerful motivating force for change in modern medicine, and is often cited as a rationale for reducing resident duty hours. However, current data suggest that resident duty hours are not significantly linked to important patient outcomes. We performed a narrative review and identified four potential explanations for these findings. First, we question the relevance of resident fatigue in the creation of harmful errors. Second, we discuss factors, including workload, experience, and individual characteristics, that may be more important determinants of resident fatigue than are duty hours. Third, we describe potential adverse effects that may arise from - and, therefore, counterbalance any potential benefits of - duty hour reductions. Fourth, we explore factors that may mitigate any risks to patient safety associated with using the services of resident trainees.
    BMC Medical Education 12/2014; 14 Suppl 1:S2. DOI:10.1186/1472-6920-14-S1-S2 · 1.41 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The 2014 National Action Plan for Adverse Drug Event Prevention has recognized adverse drug events (ADEs) as a national priority in order to facilitate a nationwide reduction in patient harms from these events. Throughout this effort, it will be integral to identify populations that may be at particular risk in order to improve care for these patients. We have undertaken a systematic review to evaluate the evidence regarding racial or ethnic disparities in ADEs with particular emphasis on anticoagulants, diabetes agents, and opioids due to the clinical significance and preventability of ADEs associated with these medication classes. From an initial search yielding 3302 studies, we identified 40 eligible studies. Twenty-seven of these included studies demonstrated the presence of a racial or ethnic disparity. There was not consistent evidence for racial or ethnic disparities in the eight studies of ADEs in general. Asians were most frequently determined to be at higher risk of anticoagulant-related ADEs and Black patients were most frequently determined to be at higher risk for diabetes agents-related ADEs. Whites were most frequently identified as at increased risk for opioid-related ADEs. However, few of these studies were specifically designed to evaluate racial or ethnic disparities, lacking a standardized approach to racial/ethnic categorization as well as control for potential confounders. We suggest the need for targeted interventions to reduce ADEs in populations that may be at increased risk, and we suggest strategies for future research.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In an effort to assess medical students' abilities to identify a medication administration error in an outpatient setting, we designed and implemented a standardized patient simulation exercise which included a medication overdose. Fourth year medical students completed a standardized patient (SP) simulation of a parent bringing a toddler to an outpatient setting. In this case-control study, the majority of students had completed a patient safety curriculum about pediatric medication errors prior to their SP encounter. If asked about medications, the SP portraying a parent was trained to disclose that she was administering acetaminophen and to produce a package with dosing instructions on the label. The administered dose represented an overdose. Upon completion, students were asked to complete an encounter note. Three hundred forty students completed this simulation. Two hundred ninety-one students previously completed a formal patient safety curriculum while 49 had not. A total of two hundred thirty-four students (69%) ascertained that the parent had been administering acetaminophen to their child. Thirty-seven students (11%) determined that the dosage exceeded recommended dosages. There was no significant difference in the error detection rates of students who completed the patient safety curriculum and those who had not. Despite a formal patient safety curriculum concerning medication errors, 89% of medical students did not identify an overdose of a commonly used over the counter medication during a standardized patient simulation. Further educational interventions are needed for students to detect medication errors. Additionally, 31% of students did not ask about the administration of over the counter medications suggesting that students may not view such medications as equally important to prescription medications. Simulation may serve as a useful tool to assess students' competency in identifying medication administration errors.
    BMC Medical Education 12/2015; 15(1). DOI:10.1186/s12909-015-0288-3 · 1.41 Impact Factor

Full-text (2 Sources)

Download
47 Downloads
Available from
May 28, 2014