Impact of a Patient-Centered Technology on Medication Errors During Pediatric Emergency Care
Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA. Ambulatory Pediatrics
(Impact Factor: 2.49).
09/2008; 8(5):329-35. DOI: 10.1016/j.ambp.2008.06.003
The aim of this study was to determine the impact of a patient-centered health information technology (HIT) on the error rate for ordering and prescribing of medications during emergency pediatric care.
We conducted a quasi-experimental intervention study by using control and intervention periods to evaluate the effect on medication ordering and prescribing from a patient-centered HIT designed to enhance communication between parents and emergency clinicians during emergency care. Parent-child dyads presenting to 2 emergency department (ED) sites with complaints of fever, asthma, head trauma, otalgia, and dysuria were eligible. During intervention periods, parents used the HIT to enter data on symptoms and medication-related history; a printout provided recommendations to clinicians. Data on errors/adverse drug events were collected via record reviews and phone interviews with parents. The primary outcome was the number of medication errors in orders or prescriptions for drugs targeted by the HIT.
Of 2002 parent-child dyads screened, 1810 (90%) were eligible, 1411 of 1810 (78%) were enrolled, and 1410 analyzed; 1097 subjects had a total of 2234 orders or prescriptions written. Of these events, 1289 of 2234 (58%) were associated with at least 1 error. Of the 1755 errors discovered, 232 errors were serious and preventable. Among 654 patients exposed to medications targeted by the HIT, the number of errors per 100 patients during control versus intervention periods was not significantly different (173 vs 134 with both sites combined; P = .35.)
The patient-centered HIT demonstrated minimal impact on medication errors during ED care.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: 1. Patients and their carers will usually be the first to notice any observable problems resulting from medication errors. They will probably be unable to distinguish between medication errors, adverse drug reactions, or ‘side effects’.
2. Little is known about how patients understand drug related problems or how they make attributions of adverse effects. Some research suggests that patients' cognitive models of adverse drug reactions bear a close relationship to models of illness perception.
3. Attributions of adverse drug reactions are related to people's previous experiences and to their level of education. The evidence suggests that on the whole patients' reports of adverse drug reactions are accurate. However, patients do not report all the problems they perceive and are more likely to report those that they do perceive as severe. Patients may not report problems attributed to their medications if they are fearful of doctors' reactions. Doctors may respond inappropriately to patients' concerns, for example by ignoring them. Some authors have proposed the use of a symptom checklist to elicit patients' reports of suspected adverse drug reactions.
4. Many patients want information about adverse drug effects, and the challenge for the professional is to judge how much information to provide and the best way of doing so. Professionals' inappropriate emphasis on adherence may be dangerous when a medication error has occurred.
5. Recent NICE guidelines recommend that professionals should ask patients if they have any concerns about their medicines, and this approach is likely to yield information conducive to the identification of medication errors.
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ABSTRACT: A quasi-experimental intervention study composed of control and intervention periods was conducted to determine if a parent-driven health information technology influenced completeness of documentation and adherence to evidence-based emergency care for children.
Structured chart abstraction was used to assess documentation and correctness of clinical actions at test ordering, medication prescribed for disease, and medication ordered for pain in a tertiary care pediatric emergency department and a suburban general emergency department. During the intervention periods, parents of children who presented with complaints related to otitis media, urinary tract infection, head trauma, or asthma entered data into a health information technology (ParentLink), which produced treatment plans in the context of evidence-based guidelines.
Of 1,410 subjects analyzed, 1,072 (76%) were assigned to one of four disease categories: urinary tract infection (22%), otitis media (20%), asthma (11%) and head trauma (47%). During ParentLink use, documentation of pain significantly improved (28% incomplete [control] versus 15% [intervention], p = .003). Incorrect actions for pain treatment decreased, but not significantly (33% [control] versus 24% [intervention], p = .13). ParentLink did not influence actions for test ordering or prescribing for disease.
Parent-driven health information technology intended to translate parents' knowledge into clinical practice and to support evidence-based care suggested a trend toward modest impact on pain management but did not demonstrate broad effects across diseases or care processes. The emergence and proliferation of personally controlled health records (PCHRs) presents opportunities for patients and parents to control their medical profiles. Although ParentLink is not a comprehensive PCHR, it represents a step in incorporating parent-derived information into medical decision making.
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ABSTRACT: Maryland hospitals have been improving the safety of medication use practices since 2000. A retrospective analysis of 35 hospitals was conducted for 2005-2007 to determine the changes in medication use practices, communication methods within hospitals, patient education and changes in medical record management.
Thirty-five Maryland hospitals completed the Institute for Safe Medication Practices Medication Safety Self-Assessment for Hospitals, a voluntary initiative to improve the safety of medication use. A weighting structure is applied to calculate key element scores, core characteristic scores and overall self-assessment scores that were used in ANOVA and regression analyses. Findings: The state-wide aggregate score significantly increased from 74.2% in 2005 to 81.2% in 2007 (p<0.05). The 35 hospitals scored highest in the following key areas in 2007: drug standardisation, storage and distribution (90.2%); drug labelling, packaging and nomenclature (88.1%); and environmental factors (84.3%). Results indicated that hospitals scored lowest in the key element area related to accessibility of patient information (72.5%) and in the core characteristics pertaining to redundancies and independent double checks (64.2%) in 2007. A substantial number of hospitals had positive and significant (p<0.05) changes in certain key elements and/or core characteristics. Few hospitals showed significant (p<0.05) decreases in their scores.
MEDSAFE has directly assisted Maryland hospitals in improving medication use safety. The strategies and tools of MEDSAFE have been used in Maryland since 2000 and Singapore and Austria since 2006.
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