BackgroundPatient survival and quality of life depend on each haemodialysis session being performed without fault. Monthly assessments of dialysis dose adequacy often fall short of this. This study reports the results of a feasibility study for the achievement of improved safety and quality in a haemodialysis session with the implementation of a 15-point checklist.MethodsFifteen quality indicators were compiled and tested in a Portuguese dialysis clinic from 1 February 2012 to 30 June 2013. The checklist was completed by the nursing staff and comprised three parts: Pre-session Safety Checks; Session Initiation Checks and Post-session Quality Checks. The maximum score that could be reached per session was 15.ResultsOne hundred and twenty-eight patients were distributed over 2–3 shifts. Of the 16 nurses employed, 4 were full time. The final average score was between 14 and 15. No nurse-specific and no shift-specific significant differences were detected. Four issues were identified that had a major effect on the results as a whole: delays in connection time; incompletely delivered treatment time; non-achievement of final body weight and failure to reach a Kt/V of at least 1.4. Improvements were most consistent in the Monday–Wednesday–Friday morning shifts compared with other shifts, and were temporarily compromised by the opening of a new shift.ConclusionsThe implementation of checklists for haemodialysis is feasible in routine clinical practice, even in clinics where only part of the staff is employed full time. The application of such checklists enhances the overall quality and safety of the delivered treatment.
Background Potentially harmful errors occur in pediatric patients at a rate three times higher than in adults, mainly due to dosage calculations. Objective. To evaluate the effect of Computerized Prescription Order Entry (CPOE) and Decision Support Systems (DSS) on Adverse Drug Events (ADE) in pediatrics. Method. Systematic review updated up to December 2019 in the PubMed, Scopus, Web of Science and Embase, Lilacs and cross-references, recorded in Prospero CRD 42019126590. Observational and pre- and post-implementation CPOE studies were included. in any language. A scale was used for methodological evaluation of the studies. Relative risk (RR), attributable risk (AR) or number needed to treat (NNT) with 95% CIs were computed for comparing the incidence of total, actual, preventable and potentially harmful ADE. Results Starting with 203 retrieved abstracts, 12 articles were included - eight interventional and four observational studies. Five articles evaluated CPOE and seven CPOE plus DSS. Settings for eleven studies were hospitals and one an outpatient facility. Sample sizes ranged from 514 to 45,615 totaling 112,187 patients. The number of prescriptions ranged from 724 to 92,398, totaling 182,803. A reduction in total ADE was observed in two studies. The risk reduction of preventable ADE ranged from 24% RR 0.76 (0.59 - 0.97) to 47% RR 0.53 (0.29-0.91) in four articles. Potentially harmful ADE (ADE ph) in five studies were reduced from 76% RR = 0.24 (0.09-0.68) to 44% (RR 0.56 (0.46 - 0.70), with an AR variyng from 1.8 to 0.9%. One of the articles stated that 64 (95% CI 25-100) patients would need to be using CPOE in order to avoid one potentially harmful ADE. Studies identified reductions in ADE in various settings- two in wards, one in wards and Pediatric Intensive Care Unit (PICU), the others in PICU and Neonatal Intensive Care Units. Conclusions Implementation of CPOE plus DSS reduces EADs in pediatric settings. Key messages Accumulated evidence favors implementation of CPOE plus DSS as important for prevention of ADE in pediatric settings. Potentially harmful and preventable errors can be avoided by implementing electronic prescribing systems in pediatrics. Its use should be encouraged in countries in low-income countries.
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