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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

Prescription errors related to the use of computerized provider order-entry system for pediatric patients.

Alhanout K, Bun SS, Retornaz K, Chiche L, Colombini N. Int J Med Inform. 2017;103:15-19.

Computerized provider order entry has been shown to decrease adverse drug events, but it can also introduce new medication errors. This retrospective study examined medication ordering errors intercepted by pharmacists for pediatric patients. As with prior studies in pediatrics, this investigation uncovered dosing errors associated with weight-based dosing, including calculation errors and missing weight information. The most common medication associated with errors was acetaminophen, which can cause severe harm if incorrectly dosed. The authors call for improving electronic health record prescribing interfaces, better user training, and enhancing communication among providers to prevent medication errors.

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

Medication safety in the neonatal intensive care unit: big measures for our smallest patients.

Rostas SE. J Perinat Neonatal Nurs. 2017;31:15-19.

Medication errors are common in the neonatal intensive care unit. This commentary outlines various strategies one teaching hospital has utilized to reduce risks of medication errors in this care setting, such as use of computerized provider order entry and smart pumps.

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

Assessing frequency and risk of weight entry errors in pediatrics.

Hagedorn PA, Kirkendall ES, Kouril M, et al. JAMA Pediatr. 2017;171:392-393

Weight-based medication dosing can lead to medication errors in pediatric patients. Investigators used a trigger tool to detect weight-entry errors in the electronic health record. They found that dosing errors are rare and are most likely to occur in urgent and emergent settings. These findings suggest that a weight-entry trigger tool can identify pediatric patients at risk for dosing errors.

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.

Special or Theme Issue

Quality of Care and Information Technology.

Suresh S, ed. Pediatr Clin North Am. 2016;63:221-388.

Utilizing informatics has shown promise for enhancing quality and patient safety, but this has also introduced unintended consequences. Articles in this special issue explore technology use in pediatric nursing care, including challenges, opportunities, and how to augment utilization of metrics and data for safety improvement.

Journal Article > Study

Effect of a real-time pediatric ICU safety bundle dashboard on quality improvement measures.

Shaw SJ, Jacobs B, Stockwell DC, Futterman C, Spaeder MC. Jt Comm J Qual Patient Saf. 2015;41:414-420.

Adherence to quality and safety measures (such as informed consent, presence of urinary catheters, deep venous thrombosis prophylaxis, and medication reconciliation) improved in a pediatric intensive care unit after implementation of an electronic dashboard which displayed real-time data about each of these practices. This study illustrates the importance of providing real-time data to frontline providers as a method to augment adherence to patient safety practices.

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.

Journal Article > Study

Preventability of voluntarily reported or trigger tool–identified medication errors in a pediatric institution by information technology: a retrospective cohort study.

Stultz JS, Nahata MC. Drug Saf. 2015;38:661-670.

Medication errors remain one of the most challenging problems in patient safety. Despite extensive investments in technological solutions such as computerized provider order entry and barcode medication administration systems, these errors still persist. This study examined all medication errors (detected by using trigger tools) over a 1-year period at an academic medical center. The investigators found that half of the errors could not have been prevented by the institution's health information technology (IT) system, and many of the avoidable errors occurred because clinicians used workarounds to bypass IT safety features. A case of a serious antibiotic overdose that took place at a fully computerized children's hospital is discussed in a recent book about the fundamental changes in health care resulting from widespread technology implementation.

Journal Article > Study

Electronic prescription writing errors in the pediatric emergency department.

Nelson CE, Selbst SM. Pediatr Emerg Care. 2015;31:368-372.

According to this retrospective chart review study, clinically significant prescription errors continued to occur at an alarming rate in a pediatric emergency department, despite the introduction of computerized provider order entry. Emergency medicine residents made more prescribing errors than pediatric residents.

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

Monitoring the harm associated with use of anticoagulants in pediatric populations through trigger-based automated adverse-event detection.

Patregnani JT, Spaeder MC, Lemon V, Diab Y, Klugman D, Stockwell DC. Jt Comm J Qual Patient Saf. 2015;41:108-114.

Warfarin and other anticoagulant medications are known to place patients at high risk of adverse drug events across multiple settings. This retrospective study examined the safety of anticoagulant therapy in hospitalized children. Researchers used a trigger approach in which abnormal laboratory test values were used to identify medical records which were reviewed for the presence or absence of an adverse drug event, an approach that has been used in other settings. They also used the administration of a reversal agent, protamine, as a trigger to detect adverse drug events. Relatively few adverse events were identified in comparison to the high number of records screened. These findings underscore the need for more sophisticated automated rules to enhance trigger-based identification of adverse drug events. A past AHRQ WebM&M commentary discussed the hazards related to prescribing warfarin and best practices to reduce risks associated with anticoagulant use.

Journal Article > Study

Color-coded prefilled medication syringes decrease time to delivery and dosing error in simulated emergency department pediatric resuscitations.

Moreira ME, Hernandez C, Stevens AD, et al. Ann Emerg Med. 2015;66:97-106.

Medication errors are common during pediatric resuscitation situations. This study found that use of prefilled and color-coded syringes reduced time needed to prepare and administer medications and significantly decreased dosing errors during simulated resuscitations.

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

Optimization of drug–drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard.

Simpao AF, Ahumada LM, Desai BR, et al. J Am Med Inform Assoc. 2015;22:361-369.

Researchers used rapid-cycle iterative interventions to improve drug interaction alerts by eliminating clinically irrelevant notifications. These efforts resulted in fewer alerts and fewer manual overrides of alerts without any serious safety events, emphasizing the often cited need to streamline clinical decision support to prevent alarm 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.

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