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Search results for "Information Professionals"

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Journal Article > Study

The effect of an electronic SBAR communication tool on documentation of acute events in the pediatric intensive care unit.

Panesar RS, Albert B, Messina C, Parker M. Am J Med Qual. 2016;31:64-68.

Use of a structured communication tool within an electronic medical record resulted in increased high-quality communication between nurses and physicians around critical patient events.

Journal Article > Study

Improving communication with primary care physicians at the time of hospital discharge.

Destino LA, Dixit A, Pantaleoni JL, et al. Jt Comm J Qual Patient Saf. 2017;43:80-88.

Adverse events after hospital discharge are common. Prior research demonstrates that communication and information transfer between inpatient providers and primary care physicians (PCPs) may be lacking, raising patient safety concerns. This study described how applying Lean methodology, enhancing frontline provider engagement, and redesigning workflow processes within the electronic health record led to improved communication with PCPs around the time of hospital discharge. Through these interventions, the pediatric medical service was able to increase verbal communication with PCPs at discharge to 80%, and they sustained this for a 7-month period. Discharge communication with PCPs across other services improved as well. A previous PSNet perspective discussed the challenges associated with care transitions and suggested opportunities for improvement.

Journal Article > Commentary

A QI initiative: implementing a patient handoff checklist for pediatric hospitalist attendings.

Lo HY, Mullan PC, Lye C, Gordon M, Patel B, Vachani J. BMJ Qual Improv Rep. 2016;5:u212920.w5661.

Patient handoffs are vulnerable to errors of omission. This quality improvement project designed and implemented a checklist as a way to standardize the process of pediatric handoffs. The program found the tool to be effective in uncovering problems and physicians felt the checklist supported situational awareness and patient safety.

Journal Article > Study

National trends in safety performance of electronic health record systems in children's hospitals.

Chaparro JD, Classen DC, Danforth M, Stockwell DC, Longhurst CA. J Am Med Inform Assoc. 2017;24:268-274.

Although computerized provider order entry (CPOE) for medications has reduced medication errors, it has also had unintended consequences. This simulation study used the validated Leapfrog evaluation tool to assess the safety of CPOE for medications for pediatric patients across multiple electronic health record (EHR) platforms. The investigators had clinicians familiar with the EHR enter prespecified unsafe orders into simulated patient records and note whether alerts or messages ensued. As demonstrated in prior work, many potentially unsafe medication orders did not lead to alerts. The authors report that repeated use of the tool led to improvement over time, which suggests the need for regular safety testing for EHRs after implementation.

Journal Article > Study

Using an inpatient portal to engage families in pediatric hospital care.

Kelly MM, Hoonakker PL, Dean SM. J Am Med Inform Assoc. 2017;24:153-161.

This study found that parents of hospitalized children used the Internet-based patient portal and reported high rates of satisfaction. Parents perceived that the portal would reduce medical errors. This work suggests that engaging patients and caregivers via health-related Internet activities could support safe inpatient care.

Journal Article > Study

Physician transition of care: benefits of I-PASS and an electronic handoff system in a community pediatric residency program.

Walia J, Qayumi Z, Khawar N, et al. Acad Pediatr. 2016;16:519-523.

The I-PASS standardized handoff protocol is considered the gold standard for inpatient handoffs, having been shown to reduce adverse events among hospitalized patients. In this study, implementation of I-PASS within an electronic medical record resulted in an improvement in handoff quality among pediatric residents. A recent PSNet interview discussed handoffs and the implementation and findings of the landmark I-PASS study.

Journal Article > Study

Frequency and severity of parenteral nutrition medication errors at a large children's hospital after implementation of electronic ordering and compounding.

MacKay M, Anderson C, Boehme S, Cash J, Zobell J. Nutr Clin Pract. 2016;31:195-206.

Computerized provider order entry with clinical decision support can be a powerful tool for alerting clinicians to potential prescribing errors. In this study at a large pediatric institution, implementation of a computerized provider order entry program for total parenteral nutrition resulted in a reduction in prescribing errors.

Book/Report

Results of the 2014 Leapfrog Hospital Survey: Computerized Physician Order Entry.

Washington, DC: Leapfrog Group; March 2015.

National hospital quality reports aim to provide benchmarks on safety and other quality measures, though questions remain regarding their universal applicability to gauge improvement. This analysis of the 2014 Leapfrog Hospital Survey results found that while the majority of hospitals employed computerized provider order entry (CPOE), not all systems provided appropriate warnings to prevent potentially harmful orders, suggesting CPOE systems still need improvement to augment safety.

Journal Article > Study

Computerized dose range checking using hard and soft stop alerts reduces prescribing errors in a pediatric intensive care unit.

Balasuriya L, Vyles D, Bakerman P, et al. J Patient Saf. 2014 Oct 31; [Epub ahead of print].

This before-and-after study found that introduction of a tiered alert system for medication dosages in pediatric patients led to an increase in alerts, but also resulted in fewer overridden alerts and more medication order revisions. This work emphasizes the need to improve electronic medication alerts to make them more actionable and reduce alert fatigue.

Journal Article > Study

Influence of a systems-based approach to prescribing errors in a pediatric resident clinic.

Condren M, Honey BL, Carter SM, et al. Acad Pediatr. 2014;14:485-490.

This study compared an outpatient pediatric clinic with pharmacist prescription medication review and electronic health record customization to one without such systems in place. The clinic with workflow and technology to prevent adverse drug events experienced fewer errors, adding to the evidence that sociotechnical approaches are needed to improve medication safety.

Journal Article > Study

Pediatric medication administration errors and workflow following implementation of a bar code medication administration system.

Hardmeier A, Tsourounis C, Moore M, Abbott WE, Guglielmo BJ. J Healthc Qual. 2014;36:54-63.

After implementation of a barcode medication administration system at a children's hospital, adherence to institutional medication safety protocols was high and the incidence of medication administration errors appeared to be low based on direct observation.

Journal Article > Study

Adverse drug event detection in pediatric oncology and hematology patients: using medication triggers to identify patient harm in a specialized pediatric patient population.

Call RJ, Burlison JD, Robertson JJ, et al. 2014;165:447-452.

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.

Journal Article > Study

Appropriateness of commercially available and partially customized medication dosing alerts among pediatric patients.

Stultz JS, Nahata MC. J Am Med Inform Assoc. 2014;21:e35-e42.

In this retrospective review of pediatric medication alerts, more than 85% of dosing alerts presented to clinicians were inappropriate. Frequent incorrect alerts contribute to alert fatigue and make clinicians more likely to override appropriate warnings.

Legislation/Regulation > Organizational Policy/Guidelines

Electronic prescribing in pediatrics: toward safer and more effective medication management.

Council on Clinical Information Technology Executive Committee. Pediatrics. 2013;131:824-826.

This policy statement outlines recommendations to ensure that electronic prescribing systems are designed and implemented to be safe for use in pediatric settings.

Journal Article > Commentary

Enhancing electronic health record usability in pediatric patient care: a scenario-based approach.

Patterson ES, Zhang J, Abbott P, et al. Jt Comm J Qual Patient Saf. 2013;39:129-135.

This commentary describes human factors, usability, and informatics recommendations for electronic health records in pediatrics to improve their usefulness and reduce the risk of errors.

Journal Article > Study

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

Avansino J, Leu MG. Pediatrics. 2012;130:e547-e552.

Despite previous mixed results for computerized provider order entry interventions, findings from this study suggest that systematically designed order sets can reduce cognitive workload and order variation.

Journal Article > Study

Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative.

Tham E, Calmes HM, Poppy A, et al. Pediatrics. 2011;128:e438-e445.

Pediatric inpatients are at high risk for adverse drug events (ADEs). Pediatric-specific trigger tools and computerized surveillance systems are effective methods to detect ADEs and identify opportunities for prevention. This performance-improvement collaborative implemented a multifaceted change strategy in 13 institutions and produced a 42% reduction in ADEs. The change strategies included efforts to reduce interruptions during medication administration, adopt consensus-based protocols and order sets, ensure high reliability with the Five Rights, and foster a culture of safety. The interventions had the greatest impact on opioid-related ADEs, which decreased by 51% across participating hospitals. The authors recommend using quality improvement collaboratives to drive improved patient care.

Journal Article > Study

Utilising improvement science methods to optimise medication reconciliation.

White CM, Schoettker PJ, Conway PH, et al. BMJ Qual Saf. 2011;20:372-380.

Medication reconciliation is necessary to reduce preventable medication errors, but despite much research, no consensus exists on how the process should be performed in either the inpatient or outpatient setting. This study, conducted at a children's hospital, demonstrates how accurate medication reconciliation can be achieved through establishing a culture of safety and rigorously applying quality improvement principles. Although the hospital had an existing electronic health record and computerized provider order entry system, a reliable medication reconciliation process was not achieved until existing processes were thoroughly analyzed, failure modes were determined, and rapid cycle tests of change were conducted. As medication reconciliation will be reinstated as a National Patient Safety Goal in July 2011, this article provides a useful blueprint for organizations tackling this difficult problem.

Journal Article > Study

Description of the development and validation of the Canadian Paediatric Trigger Tool.

Matlow AG, Cronin CM, Flintoft V, et al. BMJ Qual Saf. 2011;20:416-423.

Trigger tools are widely used as a means of detecting adverse events in adult patients. This study reports on a novel trigger tool for detection of preventable errors in hospitalized children.

Journal Article > Study

Electronic health record adoption by children's hospitals in the United States.

Nakamura MM, Ferris TG, DesRoches CM, Jha AK. Arch Pediatr Adolesc Med. 2010;164:1145-1151.

This study highlights the slow adoption of electronic health records in children's hospitals, with less than 3% having a comprehensive system in place. Hospital characteristics were not associated with implementation, and financing was the most important policy strategy identified to promote use.

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