Sinow CS, Corso I, Lorenzo J, et al. Crit Care Med. 2017;45:1915-1921.
Patients with limited English proficiency may be at higher risk for adverse events, including medication errors. Use of professional medical interpreters has been shown to improve the quality of care provided to patients with limited English proficiency. In this observational study at a single children's hospital, researchers analyzed the transcripts of nine family meetings and found that Spanish medical interpreters frequently altered the original speech of providers and family members. The authors suggest that when using medical interpreters, providers should pause frequently, allowing for translation of shorter statements to improve accuracy of translation.
This study sought to improve safe at-home pediatric medication administration through an interactive voice response intervention. Researchers found that medication dosing errors and nonadherence were common. The intervention increased medication communication but did not make parents more likely to bring medications to a physician visit as recommended. This study highlights the challenges of safe medication management for outpatients.
Roter DL, Wolff J, Wu A, et al. BMJ Qual Saf. 2017;26:508-512.
Effective team communication is a key component of safe care. This commentary discusses the role of patient–family partnerships in enhancing health care safety in ambulatory and home settings. The authors describe a communication intervention to improve patient and family collaboration during ambulatory care visits. Components of the approach included engaging family participation in routine visits and coaching them to ask questions.
Jackson PD, Biggins MS, Cowan L, et al. Rehabil Nurs. 2016;41:135-48.
Transitions are a complicated and vulnerable time for patients, particularly for those with complex care needs. This review examines the literature around care transitions and insights from patient and family advisory councils. The authors recommend standardizing the process for veterans with complex conditions and suggest focus on the use of real-time information exchange, documented care plans, and engaging patients and their families in transitions.
Tothy AS, Limper HM, Driscoll J, et al. Jt Comm J Qual Patient Saf. 2016;42:281-5.
This study reports on efforts to enhance communication between clinicians and patients in an urban pediatric emergency department. A rapid-change project resulted in significant improvement in patient perceptions of communication—clinicians were perceived as being more sensitive to patients' concerns and displayed better listening behaviors. Poor discharge communication in the emergency department has been linked to safety concerns in prior studies.
Coleman EA, Ground KL, Maul A. Jt Comm J Qual Patient Saf. 2015;41:502-7.
Efforts to improve patient safety during care transitions have had mixed success, possibly due to failure to effectively engage family and caregivers in the transition process. This study reports on the development and validation of a novel survey instrument that measures family and caregivers' preparation and self-efficacy around supporting patients at the time of hospital discharge.
Care transitions are a vulnerable time for patients, and handoff improvement is a national patient safety priority. This commentary relates how a medical student's experience with handing off a patient to an intensive care unit touches on hierarchy and a missed opportunity for transparent and family-centered communication. A past AHRQ WebM&M perspective discusses problems with inpatient handovers and recommends strategies to enhance handoff quality.
Stickney CA, Ziniel SI, Brett MS, et al. J Pediatr. 2014;165:1245-1251.e1.
In this study, health care providers and parents of children in a pediatric intensive care unit described their perceptions of family involvement in morning rounds. Although parents were overwhelmingly enthusiastic about being included in rounds, providers expressed some concerns and potential drawbacks, such as the avoidance of discussing uncomfortable topics due to presence of family.
Riley-Lawless K. J Spec Pediatr Nurs. 2009;14:94-101.
Medication reconciliation continues to be a challenging endeavor for health care systems since being elevated to a National Patient Safety Goal. This study surveyed 100 families and found that they are frequently unable to provide complete medication information about their children due to a number of highlighted barriers.
Please select your preferred way to submit a case. Note that even if you have an account, you can still choose to submit a case as a guest. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. Learn more information here.