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>
How Parents of Children With Cancer Learn About Their Children's Prognosis
Prognosis; Child; Hospitals Pediatric; Only Child
OBJECTIVES: To determine which prognostic information sources parents find informative and which are associated with better parental understanding of prognosis. METHODS: Prospective, questionnaire-based cohort study of parents and physicians of children with cancer at 2 academic pediatric hospitals. We asked parents how they learned about prognoses and evaluated relationships between information sources and prognostic understanding, defined as accuracy versus optimism. We excluded parents with pessimistic estimates and whose children had such good prognoses that optimism relative to the physician was impossible. Analytic cohort of 256 parent-physician pairs. RESULTS: Most parents considered explicit sources (conversations with oncologists at diagnosis, day-to-day conversations with oncologists, and conversations with nurses) "very" or "extremely" informative (73%-85%). Implicit sources (parent's sense of how child was doing or how oncologist seemed to feel child was doing) were similarly informative (84%-87%). Twenty-seven percent (70/253) of parents reported prognostic estimates matching physicians' estimates. Parents who valued implicit information had lower prognostic accuracy (odds ratio [OR] 0.50; 95% confidence interval 0.29-0.88), especially those who relied on a "general sense of how my child's oncologist seems to feel my child is doing" (OR 0.47; 0.22-0.99). Parents were more likely to use implicit sources if they reported receiving high-quality prognostic information (OR 3.02; 1.41-6.43), trusted the physician (OR 2.01; 1.01-3.98), and reported high-quality physician communication (OR 1.81; 1.00-3.27). CONCLUSIONS: Reliance on implicit sources was associated with overly-optimistic prognostic estimates. Parents who endorsed strong, trusting relationships with physicians were not protected against misinformation.
Sisk BA; Kang TI; Mack JW
Pediatrics
2017
<a href="http://doi.org/%2010.1542/peds.2017-2241" target="_blank" rel="noreferrer noopener">10.1542/peds.2017-2241</a>
End-of-Life Treatments in Pediatric Patients at a Government Tertiary Cancer Center in India
Hospital Mortality; Infant Newborn; Patient Admission; Human; Child; Referral and Consultation; Palliative Care; Child Preschool; Survival; Infant; Hospitals Pediatric; Adolescence; India; Inpatients; Retrospective Design; Record Review; Analgesics Opioid -- Therapeutic Use; Antianxiety Agents Benzodiazepine -- Therapeutic Use; Cancer Care Facilities -- India; Childhood Neoplasms -- Diagnosis; Childhood Neoplasms -- Drug Therapy; Childhood Neoplasms -- Mortality; Childhood Neoplasms -- Prognosis; Delirium -- Symptoms; Dyspnea -- Symptoms; Hematologic Neoplasms -- Diagnosis; Hemorrhage -- Symptoms; Pain -- Symptoms; Seizures -- Symptoms; Terminal Care -- In Infancy and Childhood; Tertiary Health Care
Jacob J; Matharu Jaskirt K; Palat G; Sinha S; Brun Eva; Wiebe T; Segerlantz M
Journal of Palliative Medicine
2018
<a href="http://doi.org/10.1089/jpm.2017.0632" target="_blank" rel="noreferrer noopener">10.1089/jpm.2017.0632</a>
Modes of Death Within a Children's Hospital
Human; Length of Stay; Child; Hospitalization; Intensive Care Units Pediatric; Treatment Failure; Referral and Consultation; Palliative Care; Hospitals Pediatric; Intensive Care Units Neonatal; Resuscitation; Confidence Intervals; Odds Ratio; Qualitative Studies; Descriptive Statistics; Race Factors; Retrospective Design; Whites; Blacks; Hospital Mortality -- In Infancy and Childhood; Multiple Logistic Regression
BACKGROUND: Knowledge about how children die in pediatric hospitals is limited, and this hinders improvement in hospital-based end-of-life care. METHODS: We conducted a retrospective chart review of all the patients who died in a children's hospital between July 2011 and June 2014, collecting demographic and diagnostic information, hospital length of stay, location of death, and palliative care consultation. A qualitative review of provider notes and resuscitation records was used to create 5 mutually exclusive modes of death, which were then assigned to each patient. Analysis included the calculation of descriptive statistics and multinomial logistic regression modeling. RESULTS: We identified 579 patients who were deceased; 61% were <1 year of age. The ICU was the most common location of death (NICU 29.7%; PICU 27.8%; cardiac ICU 16.6%). Among the 5 modes of death, the most common was the withdrawal of life-sustaining technology (40.2%), followed by nonescalation (25.6%), failed resuscitation (22.8%), code then withdrawal (6.0%), and death by neurologic criteria (5.3%). After adjustment, patients who received a palliative care consultation were less likely to experience a code death (odds ratio 0.31; 95% confidence interval 0.13--0.75), although African American patients were more likely than white patients to experience a code death (odds ratio 2.46; 95% confidence interval 1.05--5.73), mostly because of code events occurring in the first 24 hours of hospitalization. CONCLUSIONS: Most deaths in a children's hospital occur in ICUs after the withdrawal of life-sustaining technology. Race and palliative care involvement may influence the manner of a child's death.
Trowbridge A; Walter JK; McConathey E; Morrison W; Feudtner C
Pediatrics
2018
<a href="http://doi.org/10.1542/peds.2017-4182" target="_blank" rel="noreferrer noopener">10.1542/peds.2017-4182</a>