Search results for "Health Care Executives and Administrators"

Drug shortages have become increasingly common in recent years, especially in the United States. Some pediatric chemotherapeutics have frequently been in short supply, posing serious risks to patient safety. This commentary describes an ethical framework developed by a multidisciplinary group of experts and a panel of peer consultants. The framework seeks to guide clinicians' decision-making around allocating life-saving chemotherapies and associated drugs for children with cancer. The authors describe methods for managing shortages by reducing waste. The guideline also provides clear reasoning for actual prioritization across and within common pediatric cancers during a drug shortage. For example, in cases where shortages lead to the inability to provide the standard of care for some children, the authors propose emphasizing curability and prognosis in determining who is likely to have the most benefit. In 2013, the FDA released a strategic plan for preventing drug shortages, but the problem has continued largely unabated.

This study sought to evaluate the safety and diagnostic accuracy of biopsies in pediatric patients with cancer. Analysis of biopsy procedures in children with suspected cancer over a 10-year period found few safety incidents and a low risk of diagnostic error.

Chemotherapy is a high-risk treatment that requires specific safety protocols. This commentary describes an effort that successfully determined and implemented best practices for chemotherapy administration in children. The intervention included an interdisciplinary program that reviewed current processes and evidence, utilized quality improvement tools, and established standardized techniques, exact times, and consistent documentation to augment safety associated with use of this medication.

To investigate the utility of a trigger tool in detecting adverse drug events (ADEs) in pediatric hematology and oncology patients, this study compared the tool with a voluntary reporting system. Implementation of the trigger tool led to inclusion of many cases that were not ADEs (false positives). In contrast, voluntary reporting did not identify all ADEs that were found using the trigger tool, implying under-reporting. These results reinforce prior research suggesting that multiple detection methods are needed to comprehensively detect ADEs. The authors advocate for triggers to be refined according to patient population and hospital setting to augment their usefulness. A previous AHRQ WebM&M perspective discusses the role of trigger tools in identifying ADEs and measuring patient safety.

Shortages of medications pose ethical, efficiency, and safety challenges for prescribers. This consensus statement makes recommendations to help guide policy development and promote proactive response to reduce the potential for pediatric chemotherapy drug shortages.

Children with cancer are particularly vulnerable to medication errors. This review describes how to enhance safe medication use in pediatric oncology through establishing a safety culture, integrating high reliability principles, and teamwork training.

The significant toxicity and individualized dosing required for chemotherapy may lead to serious medication errors. Medication administration protocols and checklists are often employed for administering chemotherapy. This observational study within a tertiary hospital in urban India found that errors occurred in 13.6% of observed medication administrations, and the majority of errors were not intercepted. The harm associated with these errors led to increased need for monitoring in some cases, but no permanent harm or death. A past AHRQ WebM&M perspective described a widely known incident of chemotherapy medication overdose.

An Institute of Medicine report raised serious concerns about the safety and quality of cancer care. This study found that implementation of a checklist for outpatient visits was associated with increased accuracy of medication lists and clinical documentation in a pediatric oncology clinic.

A multidisciplinary, pharmacy-associated intervention halved the number of pediatric chemotherapy errors at a single institution (from 3.9 to 1.8 per 1000 medications dispensed) but failed to achieve its goal of a Six Sigma error rate.

The nationwide unavailability of certain prescription medications has posed a potential patient safety problem, as these shortages have been increasingly common over the past few years. This study shows clear evidence that drug shortages can result in patient harm. In 2009, a shortage of mechlorethamine (a standard component of chemotherapy regimens for childhood leukemia) forced oncologists to treat patients with an alternative agent, cyclophosphamide (which was thought to be equally effective). This article demonstrates that children who received cyclophosphamide clearly had a higher rate of treatment failure, resulting in the need for further chemotherapy and bone marrow transplantation. This finding adds to other recent studies documenting clinical consequences directly related to drug shortages.

This study found that omission and administration errors were the most common types of medication errors in a pediatric oncology population.

This case report illustrates the benefits of utilizing a rapid response team (RRT) in the outpatient setting, and discusses broader findings of RRT use at a pediatric hospital.

This article discusses how a criminal prosecution has deeply affected an Ohio pharmacist who lost his license and is serving a prison sentence for failing to detect a medical error, which led to the death of a child.

The authors describe the implementation of daily care rounds. Surveys revealed that staff thought these rounds improved communication and patient safety.

This small cohort study demonstrated that dosing or administration errors occurred with nearly 10% of oral chemotherapeutic drugs administered to pediatric outpatients.

This study utilized a multidisciplinary team of oncology providers to conduct a failure mode and effects analysis (FMEA) and generate recommendations for implementing a computerized provider order entry (CPOE) system. Investigators tracked more than 1000 chemotherapy orders before and after CPOE implementation and discovered lower rates of ordering errors with the new process. Discussion includes specific recommendations that resulted from the FMEA and presentation of the error types (eg, order and treatment plan match, correct calculation, nursing checklist present) noted during the study period. The authors acknowledge the importance of CPOE as a tool to reduce chemotherapy-related medication errors and advocate for close collaboration among clinical and information technology experts to drive such interventions.

This study discusses the experiences of a single institution in using failure mode and effects analysis (FMEA) to develop strategies for reducing the risk of chemotherapeutic medication errors. The authors outline the operational steps in assembling a FMEA team, a detailed account of the process itself, and the mechanism by which they categorized their recommendations (ie, prescribing, dispensing, and administration). They further discuss the results of their experience, the strategies that were developed, and the postimplementation results. These results included a decreased error rate in prescribing, an increased use of preprinted order sets, and a decreasing number of dispensing and administration errors.

The authors applied the VA's Health Care Failure Mode and Effect Analysis (HFMEA) process to vincristine errors and found the tool to be effective in identifying failure.