A paradigm shift to balance safety and quality in pediatric pain management.

Jeffrey R. Avansino; Lisa M. Peters; Shellie L. Stockfish; Gary A. Walco

Study

A paradigm shift to balance safety and quality in pediatric pain management.

March 6, 2013

Avansino JR, Peters LM, Stockfish SL, et al. Pediatrics. 2013;131(3):e921-7.

View more articles from the same authors.

This study reports on a multidisciplinary quality improvement effort to optimize pain management in children undergoing hernia surgery and minimize adverse drug events.

PubMed citation

Available at

Free full text

Related Resources From the Same Author(s)

Effects of CPOE on provider cognitive workload: a randomized crossover trial.

September 5, 2012

Retained guidewires in the Veterans Health Administration: getting to the root of the problem.

May 9, 2018

Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States.

July 16, 2008

Medication error reporting in rural critical access hospitals in the North Dakota Telepharmacy Project.

January 22, 2014

Do emergency physicians attribute drug-related emergency department visits to medication-related problems?

January 20, 2010

Building and sustaining a systemwide culture of safety.

December 14, 2005

A concept analysis of situational awareness in nursing.

April 17, 2013

Outcomes of emergency department patients presenting with adverse drug events.

March 16, 2011

Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations.

April 18, 2007

Sentara Norfolk General Hospital: accelerating improvement by focusing on building a culture of safety.

March 6, 2005

Effects of weekend admission and hospital teaching status on in-hospital mortality.

March 6, 2005

Measuring team performance in healthcare: review of research and implications for patient safety.

June 25, 2008

Nursing crew resource management: a follow-up report from the Veterans Health Administration.

March 13, 2013

Impact of introducing an electronic physiological surveillance system on hospital mortality.

October 15, 2014

Improving patient safety and optimizing nursing teamwork using crew resource management techniques.

March 14, 2012

"You just want to feel safe when you go to a healthcare professional:" intimate partner violence and patient safety.

August 2, 2023

The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry.

March 6, 2005

Controversy and quality improvement: lingering questions about ethics, oversight, and patient safety research.

May 28, 2008

Trainee autonomy and patient safety.

December 6, 2017

Root cause analysis of reported patient falls in ORs in the Veterans Health Administration.

October 24, 2018

Quality gaps identified through mortality review.

February 1, 2017

Consensus statement on effective communication of urgent diagnoses and significant, unexpected diagnoses in surgical pathology and cytopathology from the College of American Pathologists and Association of Directors of Anatomic and Surgical Pathology.

October 26, 2011

A 5-year analysis of rapid response system activation at an in-hospital haemodialysis unit.

July 14, 2010

Medical diagnoses commonly associated with pediatric malpractice lawsuits in the United States.

December 17, 2008

Improving patient safety using the sterile cockpit principle during medication administration: a collaborative, unit-based project.

February 13, 2013

Results of the Medications At Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission.

March 17, 2010

Operating management system for high reliability: leadership, accountability, learning and innovation in healthcare.

September 5, 2018

Electronic medical record availability and primary care depression treatment.

September 26, 2012

Clinic design for safety during the pandemic: safety or teamwork, can we only pick one?

May 11, 2022

Patterns of dementia treatment and frank prescribing errors in older adults with Parkinson disease.

October 24, 2018

Potential safety gaps in order entry and automated drug alerts: a nationwide survey of VA physician self-reported practices with computerized order entry.

June 22, 2011

Comparison of medication safety effectiveness among nine critical access hospitals.

January 8, 2014

Laney's story: the problem of delayed diagnosis of pediatric stroke.

April 24, 2019

Linking acknowledgement to action: closing the loop on non-urgent, clinically significant test results in the electronic health record.

April 15, 2015

Failure mode and effects analysis to reduce risk of heparin use.

January 29, 2020

The nurse's role in the causation of compensable injury.

October 12, 2011

COVID-19: patient safety and quality improvement skills to deploy during the surge.

June 24, 2020

Surgical programs in the Veterans Health Administration maintain briefing and debriefing following medical team training.

April 30, 2014

Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study.

June 18, 2008

Implementation of a "second victim" program in a pediatric hospital.

April 8, 2015

The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process.

June 20, 2007

Postoperative sepsis in the United States.

January 19, 2011

Improving patient safety in intensive care units in Michigan.

June 25, 2008

A learning health system agenda for organizational approaches to enhancing occupational well-being among clinicians.

May 25, 2022

Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port.

January 25, 2006

Non–health care facility medication errors resulting in serious medical outcomes.

July 26, 2017

Failure to recognize newly identified aortic dilations in a health care system with an advanced electronic medical record.

July 22, 2009

Understanding interdisciplinary health care teams: using simulation design processes from the Air Carrier Advanced Qualification Program to identify and train critical teamwork skills.

December 9, 2009

Detection of potential look-alike/sound-alike medication errors using Veterans Affairs administrative databases.

November 28, 2018

Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care.

April 25, 2018

Medication reconciliation in ambulatory care: attempts at improvement.

October 28, 2009

Clinical pharmacists and inpatient medical care: a systematic review.

May 17, 2006

A model for the departmental quality management infrastructure within an academic health system.

September 28, 2016

Curriculum development and implementation of a national interprofessional fellowship in patient safety.

September 5, 2018

Teamwork behaviours and errors during neonatal resuscitation.

March 24, 2010

Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.

April 27, 2011

Creating high reliability in health care organizations.

December 20, 2006

The problem with medication reconciliation.

August 31, 2016

View the world through a different lens: shadowing another provider.

October 8, 2008

Failure mode and effects analysis: a comparison of two common risk prioritisation methods.

May 4, 2016

Pediatric ADHD medication exposures reported to US poison control centers.

June 6, 2018

Case study: getting boards on board at Allen Memorial Hospital, Iowa Health System.

April 2, 2008

NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit.

January 20, 2010

Improving adverse drug event detection in critically ill patients through screening intensive care unit transfer summaries.

July 31, 2013

In situ simulation: detection of safety threats and teamwork training in a high risk emergency department.

June 5, 2013

The role for leaders of health care organizations in patient safety.

September 19, 2007

Patient safety on the otolaryngology service: the role of an established rapid response system.

January 6, 2010

National estimates of adverse events during nonpsychiatric hospitalizations for persons with schizophrenia.

August 25, 2010

Eight years of decreased methicillin-resistant Staphylococcus aureus health care–associated infections associated with a Veterans Affairs prevention initiative.

February 22, 2017

Outcomes of concurrent operations: results from the American College of Surgeons' National Surgical Quality Improvement Program.

October 11, 2017

Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project.

August 18, 2010

Antidepressant and antipsychotic medication errors reported to United States poison control centers.

November 28, 2018

Nursing strategies to increase medication safety in inpatient settings.

May 25, 2016

Better off not knowing: improving clinical care by limiting physician access to unsolicited diagnostic information.

April 13, 2011

Sharing lessons learned to prevent incorrect surgery.

November 21, 2012

Errors upstream and downstream to the Universal Protocol associated with wrong surgery events in the Veterans Health Administration.

April 29, 2015

The role of technology in clinician-to-clinician communication.

August 14, 2013

The frequency of missed test results and associated treatment delays in a highly computerized health system.

June 6, 2007

Adequacy of information transferred at resident sign-out (in-hospital handover of care): a prospective survey.

February 20, 2008

Use of medical emergency team responses to reduce hospital cardiopulmonary arrests.

March 27, 2005

Use of medical emergency team (MET) responses to detect medical errors.

March 6, 2005

Types, prevalence, and potential clinical significance of medication administration errors in assisted living.

June 4, 2008

Errors prevented by and associated with bar-code medication administration systems.

May 2, 2007

Prescription opioid exposures among children and adolescents in the United States: 2000–2015.

June 14, 2017

Non–health care facility cardiovascular medication errors in the United States.

November 1, 2017

The Daily Goals Communication Sheet: a simple and novel tool for improved communication and care.

October 8, 2008

Trigger alerts associated with laboratory abnormalities on identifying potentially preventable adverse drug events in the intensive care unit and general ward.

August 1, 2018

Understanding and preventing wrong-patient electronic orders: a randomized controlled trial.

July 18, 2012

Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology.

October 15, 2014

What context features might be important determinants of the effectiveness of patient safety practice interventions?

June 29, 2011

The role of theory in research to develop and evaluate the implementation of patient safety practices.

January 30, 2005

Crisis management during anaesthesia: the development of an anaesthetic crisis management manual.

June 22, 2005

Disclosing large scale adverse events in the US Veterans Health Administration: lessons from media responses.

April 13, 2016

Analysis of risk factors for adverse drug events in critically ill patients.

April 11, 2012

Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving a labor and delivery ward.

September 9, 2009

Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

May 6, 2015

Defining and measuring patient safety.

March 6, 2005

Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform.

September 12, 2007

Evaluation of symptom checkers for self diagnosis and triage: audit study.

July 29, 2015

Medication errors in HIV-infected hospitalized patients: a pharmacist's impact.

July 10, 2013

Related Resources

Handoff tool improves transitions from the operating room to the neonatal intensive care unit.

November 8, 2023

Error traps in pediatric patient blood management in the perioperative period.

September 6, 2023

In their own words: safety and quality perspectives from families of hospitalized children with medical complexity.

September 6, 2023

Compliance with central line maintenance bundle and infection rates.

August 23, 2023

Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis.

August 9, 2023

Using a human factors framework to assess clinician perceptions of and barriers to high reliability in hand hygiene.

June 14, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.

March 8, 2023

WebM&M Cases

Aspergillus Mediastinitis & Endocarditis in a Pediatric Patient Complicating Cardiac Surgery and Bedside Chest Closure.

February 1, 2023

Quality and Safety.

November 2, 2022

Standardization of pediatric noncardiac operating room to intensive care unit handoffs improves communication and patient care.

October 5, 2022

To err is human, but what happens when surgeons err?

September 28, 2022

Error traps in acute pain management in children.

September 21, 2022

Trial and error: learning from malpractice claims in childhood surgery.

August 24, 2022

Incidence and characteristics of errors detected by a short team briefing in pediatric anesthesia.

August 24, 2022

Adverse events in infants less than 6 months of age after ambulatory surgery and diagnostic imaging requiring anesthesia.

August 10, 2022

Pediatric surgical errors: a systematic scoping review.

July 20, 2022

Implicit racial bias in pediatric orthopaedic surgery.

June 15, 2022

WebM&M Cases

Intraosseous Line Extravasation in a Pediatric Trauma Patient

April 27, 2022

Where trust flourishes: perceptions of clinicians who trust their organizations and are trusted by their patients.

January 12, 2022

Opioid prescribing to US children and young adults in 2019.

September 1, 2021

Association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids.

August 25, 2021

Adverse events and emergency department opioid prescriptions in adolescents.

June 30, 2021

Implementation of a parent-centered approach to the preinduction checklist in pediatric surgery.

February 3, 2021

Guidelines for opioid prescribing in children and adolescents after surgery: an expert panel opinion.

December 2, 2020

Children and the opioid epidemic: age-stratified exposures and harms.

October 21, 2020

Race, postoperative complications, and death in apparently healthy children.

August 12, 2020

Classification of opioid dependence, abuse, or overdose in opioid-naive patients as a "Never Event".

August 5, 2020

Indication-specific opioid prescribing for US patients with Medicaid or private Insurance, 2017

June 10, 2020

Before mea culpa, Children’s was confident its air systems weren’t source of infection

December 11, 2019

See More About The Topic

Operating Room

Children's Hospitals

Health Care Providers

Pediatrics

Pediatric Surgery

A paradigm shift to balance safety and quality in pediatric pain management.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

A paradigm shift to balance safety and quality in pediatric pain management.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site