Children with medical complexity: A concept analysis
Child; Chronic Disease; children with medical complexity; Data Analysis; nursing care of children with medical complexity; pediatric medical complexity
AIM: The aim of this paper is to conduct a concept analysis on the term, "children with medical complexity." BACKGROUND: Children with medical complexity (CMC) describes pediatric patients with chronic, sustained acuity; however, there is a lack of consensus in the literature regarding its exact meaning, characteristics, and implications. DESIGN: This analysis relied upon the framework described by Walker and Avant. DATA SOURCE: The CINAHL, MEDLINE, and PubMed databases were queried from April 2020 to December 2020 with an initial search of the literature for the keyword, "children with medical complexity" and other associated terms, such as "pediatric medical complexity" and "nursing care of children with medical complexity." REVIEW METHODS: This analysis will explore the concept of CMC and its significance, attributes, antecedents, and consequences. RESULTS: This investigation revealed that CMC are a growing population of pediatric patients who have one or more complex chronic conditions that affect multiple body systems, experience functional limitations, require extensive care coordination from multiple providers, and are dependent upon life-sustaining medical technology. CONCLUSIONS: The findings can serve as a foundation for future work advancing the understanding of the topic of CMC.
Rogers J; Reed MP; Blaine K; Manning H
Nursing Forum
2021
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<a href="http://doi.org/10.1111/nuf.12559" target="_blank" rel="noreferrer noopener">10.1111/nuf.12559</a>
Medication Order Errors at Hospital Admission Among Children With Medical Complexity
Medication Errors; Medication Reconciliation; Child; Hospitalization; Hospitals Pediatric; Humans; Patient Admission; Prospective Studies
OBJECTIVES: We sought to characterize the nature and prevalence of medication order errors (MOEs) occurring at hospital admission for children with medical complexity (CMC), as well as identify the demographic and clinical risk factors for CMC experiencing MOEs. METHODS: Prospective cohort study of 1233 hospitalizations for CMC from November 1, 2015, to October 31, 2016, at 2 children's hospitals. Medication order errors at admission were identified prospectively by nurse practitioners and a pharmacist through direct patient care. The primary outcome was presence of at least one MOE at hospital admission. Statistical methods used included χ2 test, Fisher exact tests, and generalized linear mixed models. RESULTS: Overall, 6.1% (n = 75) of hospitalizations had ≥1 MOE occurring at admission, representing 112 total identified MOEs. The most common MOEs were incorrect dose (41.1%) and omitted medication (34.8%). Baclofen and clobazam were the medications most commonly associated with MOEs. In bivariable analyses, MOEs at admission varied significantly by age, assistance with medical technology, and numbers of complex chronic conditions and medications (P < 0.05). In multivariable analysis, patients receiving baclofen had the highest adjusted odds of MOEs at admission (odds ratio, 2.2 [95% confidence interval, 1.2-3.8]). CONCLUSIONS: Results from this study suggest that MOEs are common for CMC at hospital admission. Children receiving baclofen are at significant risk of experiencing MOEs, even when orders for baclofen are correct. Several limitations of this study suggest possible undercounting of MOEs during the study period. Further investigation of medication reconciliation processes for CMC receiving multiple chronic, home medications is needed to develop effective strategies for reducing MOEs in this vulnerable population.
Blaine K; Wright J; Pinkham A; O'Neill M; Wilkerson S; Rogers J; McBride S; Crofton C; Grodsky S; Hall D; Mauskar S; Akula V; Khan A; Mercer A; Berry JG
Journal of Patient Safety
2022
<a href="http://doi.org/10.1097/pts.0000000000000719" target="_blank" rel="noreferrer noopener">10.1097/pts.0000000000000719</a>