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Search results for "United States of America"

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Journal Article > Study

Pediatric prehospital medication dosing errors: a national survey of paramedics.

Hoyle JD Jr, Crowe RP, Bentley MA, Beltran G, Fales W. Prehosp Emerg Care. 2017;21:185-191.

This survey of paramedics found that pediatric dosing errors in the prehospital period are common. Respondents used varied methods for estimating weight of pediatric patients in order to calculate drug doses, and they advocated for pediatric training and standardized weight estimation methods to reduce risks. These findings suggest several possible interventions to enhance pediatric medication safety in the prehospital setting.

Journal Article > Study

Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study.

Guise JM, Hansen M, O'Brien K, et al. BMJ Open. 2017;7:e014057.

Prehospital emergencies are time critical, and they occur in uncontrolled and often challenging environments. Although emergency medical services (EMS) providers are known to experience high levels of stress, whether their stress contributes to patient safety problems is unclear. In this qualitative study, investigators analyzed perceptions of stress and safety in pediatric out-of-hospital emergencies. They identified factors that contribute to increased stress and therefore adversely affect patient safety, including provider sympathy for children and identification with children or family, which participants felt could cloud their clinical judgment, and lack of familiarity with pediatric emergencies, as seen in other clinical settings. This study highlights a need for specific pediatric training for EMS providers to enhance safety.

Journal Article > Review

Ethics in the pediatric emergency department: when mistakes happen: an approach to the process, evaluation, and response to medical errors.

Dreisinger N, Zapolsky N. Pediatr Emerg Care. 2017;33:128-131.

Emergency departments (ED) are complex environments that are prone to medical error. This review discusses elements of ED care that detract from patient safety and highlights the importance of reporting and discussing errors when they take place to develop prevention strategies. The authors also explore the evidence on transparency in the ED when an error occurs and how to make an appropriate apology.

Journal Article > Study

Radiologic safety events within a pediatric emergency medicine network.

Blumberg SM, Mahajan PV, O'Connell KJ, et al. Pediatr Emerg Care. 2017;33:92-96.

This study analyzed a database of voluntarily reported errors to determine the types of radiologic errors encountered in a regional pediatric emergency medicine network. Radiologic errors accounted for 7% of all incident reports, of which the most common were incorrect or changed interpretations of studies. Individual errors—including clinical judgment or failure to follow established safety procedures—were judged to be more common than system factors, though only half of the incident reports described contributing causes.

Journal Article > Commentary

Handoffs: transitions of care for children in the emergency department.

American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American College of Emergency Physicians Pediatric Emergency Medicine Committee; Emergency Nurses Association Pediatric Committee. Pediatrics. 2016;138:e20162680.

Improvement efforts have focused on care transitions, which are known to be vulnerable to communication failures. This guideline provides recommendations for ensuring handoffs are performed in pediatric emergency care and suggests adherence to standard communication methods, coupled with effective training on the use of those tools, can improve the safety of transitions.

Journal Article > Study

Emergency medical services provider pediatric adverse event rate varies by call origin pediatric emergency care.

Jones D, Hansen M, Van Otterloo J, Dickinson C, Guise JM. Pediatr Emerg Care. 2016 Jul 12; [Epub ahead of print].

Emergency medical services may transport patients from the scene of an accident, an outpatient clinic, or a hospital. This study found that rates of adverse events and near misses were higher when pediatric patients came from accident scenes or clinics than if patients were transferred from other hospitals.

Journal Article > Study

Pediatric airway management and prehospital patient safety: results of a national Delphi survey by the Children's Safety Initiative-Emergency Medical Services for Children.

Hansen M, Meckler G, O'Brien K, et al. Pediatr Emerg Care. 2016;32:603-607.

Appropriate airway management is a key component of resuscitation in the prehospital setting. This study surveyed prehospital professionals to understand elements of prehospital pediatric airway management that may contribute to patient safety events. Investigators found that insufficient experience with pediatric airway management and difficulty deciding when an advanced airway should be performed were viewed as highly likely to lead to safety events.

Journal Article > Study

The Ask Me to Explain campaign: a 90-day intervention to promote patient and family involvement in care in a pediatric emergency department.

Tothy AS, Limper HM, Driscoll J, Bittick N, Howell MD. Jt Comm J Qual Patient Saf. 2016;42:281-286.

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.

Journal Article > Study

Near misses and unsafe conditions reported in a Pediatric Emergency Research Network.

Ruddy RM, Chamberlain JM, Mahajan PV, et al; Pediatric Emergency Care Applied Research Network. BMJ Open. 2015;5:e007541.

This study of incident reports from pediatric emergency departments found that a small proportion reported near misses or unsafe conditions. Common issues included medication safety, handoffs, human factors, and systems vulnerabilities, all of which are known to lead to patient harm. Prior studies have found that incident reporting is often underused. This study highlights its importance as a lens into safety problems.

Journal Article > Study

Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: a randomized crossover trial.

Stevens AD, Hernandez C, Jones S, et al. Resuscitation. 2015;96:85-91.

This randomized simulation study compared paramedics' ability to correctly dose medications for pediatric patients with color-coded prefilled syringes versus traditional medication kits. Researchers found that color-coded prefilled syringes improved dose accuracy and decreased time to medication delivery, demonstrating how a system intervention can enhance clinical performance.

Journal Article > Study

Evaluation for occult fractures in injured children.

Wood JN, French B, Song L, Feudtner C. Pediatrics. 2015;136:232-240.

This study assessed an error of omission—failure to assess children for occult fractures—in several clinically indicated situations, and found that such errors occur in about half of cases. Interventions to prompt specific actions, like checklists, may be useful in this clinical arena.

Journal Article > Study

Pediatric emergency department discharge prescriptions requiring pharmacy clarification.

Caruso MC, Gittelman MA, Widecan ML, Luria JW. Pediatr Emerg Care. 2015;31:403-408.

This chart review study found that callbacks from retail pharmacies to a pediatric emergency department were usually related to insurance or clinically insignificant errors, but more than 10% were considered at least significant. These findings demonstrate the need for more robust decision support in electronic prescribing.

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.

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

Detection of missed injuries in a pediatric trauma center with the addition of acute care pediatric nurse practitioners.

Resler J, Hackworth J, Mayo E, Rouse TM. J Trauma Nurs. 2014;21:272-275.

Missed injuries and delayed diagnoses are a relatively common problem in trauma care. This study describes a 150% increase in the number of documented missed injuries that were caught following the introduction of acute care nurse practitioners on a pediatric trauma service. The authors attribute the uptick in identified missed injuries to better charting and follow-up examinations.

Journal Article > Study

Adverse drug event–related emergency department visits associated with complex chronic conditions.

Feinstein JA, Feudtner C, Kempe A. Pediatrics. 2014;133:e1575-e1585.

This retrospective cohort study found that children with complex chronic conditions are at higher risk for adverse drug events that lead to emergency department visits but not hospital admissions, compared with other children. Psychotropic medications were the most common cause of adverse drug events in this vulnerable population.

Journal Article > Study

National patterns of codeine prescriptions for children in the emergency department.

Kaiser SV, Asteria-Penaloza R, Vittinghoff E, Rosenbluth G, Cabana MD, Bardach NS. Pediatrics. 2014;133:e1139-e1147.

Codeine is considered a high-risk medication in children due to variability in its metabolization. Despite recommendations against its use, this analysis of national data over a 10-year period found only a slight decrease in codeine prescriptions for children seen in the emergency department.

Journal Article > Study

Facilitating a safe transition from the pediatric emergency department to home with a post-discharge phone call: a quality-improvement initiative to improve patient safety.

Bucaro PJ, Black E. J Emerg Nurs. 2014;40:245-252.

In this study, nurses, physicians, and caregivers reported that a telephone call from a registered nurse after discharge from the pediatric emergency department (ED) was valuable and increased parents' understanding of the care plan. The authors determined that post-discharge telephone calls did not decrease return visits because the telephone nurse referred patients back to the ED if needed.

Journal Article > Study

Errors and error-producing conditions during a simulated, prehospital, pediatric cardiopulmonary arrest.

Lammers RL, Willoughby-Byrwa M, Fales WD. Simul Healthc. 2014;9:174-183.

Simulations of prehospital pediatric cardiopulmonary arrest uncovered many potential errors. Most notably, medication errors related to the correct weight-based dosing of epinephrine were common. This mistake can have serious consequences and warrants further efforts to mitigate this risk.

Journal Article > Study

Cough and cold medication adverse events after market withdrawal and labeling revision.

Hampton LM, Nguyen DB, Edwards JR, Budnitz DS. Pediatrics. 2013;132:1047-1054.

Emergency department visits for cold and cough medication–related adverse events among children younger than 3 years declined significantly following manufacturers' voluntary withdrawal from the market and label revisions.

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