BACKGROUND AND OBJECTIVE: Experts suggest family engagement in care can improve safety for hospitalized children. Family-centered rounds (FCRs) can offer families the opportunity to participate in error recovery related to children's medications. The objective of this study was to describe family-initiated dialogue about medications and health care team responses to this dialogue during FCR to understand the potential for FCR to foster safe medication use.METHODS: FCR were video-recorded daily for 150 hospitalized children. Coders sorted family-initiated medication dialogue into mutually exclusive categories, reflecting place of administration, therapeutic class, topic, and health care team responses. Health care team responses were coded to reflect intent, actions taken by the team, and appropriateness of any changes.RESULTS: Eighty-three (55%) of the 150 families raised 318 medication topics during 347 FCR. Most familyinitiated dialogue focused on inpatient medications (65%), with home medications comprising 35%. Antiinfectives (31%), analgesics (14%), and corticosteroids (11%) were the most commonly discussed medications. The most common medication topics raised by families were scheduling (24%) and adverse drug reactions (11%). Although most health care team responses were provision of information (74%), appropriate changes to the child's medications occurred in response to 8% of family-initiated dialogue, with most changes preventing or addressing adverse drug reactions or scheduling issues.CONCLUSIONS: Most families initiated dialogue regarding medications during FCRs, including both inpatient and home medications. They raised topics that altered treatment and were important for medication safety, adherence, and satisfaction. Study findings suggest specific medication topics that health care teams can anticipate addressing during FCR. WHAT'S KNOWN ON THIS SUBJECT:Family engagement in the care of hospitalized children may improve outcomes, including medication safety. Although family-centered rounds (FCRs) provide a venue for family engagement in care, how families use this venue to influence medication-related topics is unknown. WHAT THIS STUDY ADDS:Most families initiated medication-related dialogue during FCRs, discussing inpatient and home medications. Topics raised were important for medication adherence and safety, even altering treatment plans. Findings suggest specific medication topics that health care team members can anticipate addressing during FCR.

Purpose To improve patient safety and reduce drug waste through implementation of automated parenteral chemotherapy dose-banding within an electronic health record. Methods Parenteral chemotherapy dose-rounding practices were transitioned from a manual, pharmacist-driven workflow to an automated process within the electronic health record. Initial medications transitioned included bevacizumab, rituximab, and trastuzumab. Dose-banding tables were built to standardize rounding within a 10% parameter and then subsequently incorporated into the electronic health record after receiving multidisciplinary approval. Following implementation, a retrospective chart review was performed to compare drug and associated cost savings with manual dose-rounding and automated dose-banding. Medication safety improvements were measured by comparing the change in the number of clicks needed for pharmacist verification as well as by evaluation of submissions to our event reporting system. Results After implementing automated parenteral chemotherapy dose-banding, reported medication errors associated with the parenteral chemotherapy rounding process decreased. The number of event submissions related to incorrect rounding decreased from four submissions in the pre-implementation period to zero in the post-implementation period. Automation saved pharmacists at least 9,297 additional clicks and 11,363 additional keystrokes and also led to notable increases in total drug savings as well as drug cost savings. Conclusion Overall safety of our parenteral chemotherapy ordering processes within our electronic health record was improved after the implementation of automated dose-banding. By standardizing the administered doses for three chemotherapy agents, we were also able to increase total drug savings and associated drug cost savings.

Objectives. To implement an anticoagulation guide (AG) and measure understanding with an audience response system (ARS). Secondly, to describe prescribing practices following AG implementation and survey pharmacy students' opinions of the ARS. Methods. Medical and pharmacy residents, pharmacy students, and clinical staff pharmacists responded to 7 case-based multiple-choice questions related to anticoagulation with the ARS before and after an educational intervention. Following AG implementation, a retrospective medical record review measured prescriber adherence to the guide's warfarin initiation protocol (target adherence was 75%). A survey was administered to pharmacy students via the ARS.Results. There were significant increases in the number of preferred responses given by physicians, pharmacists, and pharmacy students on an examination administered using an ARS after completing the educational intervention. Prescriber adherence to the warfarin initiation protocol was noted in 22 of 43 (51%) of the medical records reviewed post-intervention. Conclusion. Use of an ARS improved understanding of the anticoagulation guide as evident by a significant increase in preferred responses on the post-education examination. A majority of pharmacy students surveyed responded that the ARS improved lecture involvement and understanding. However, target prescriber adherence to the warfarin initiation protocol was not achieved.

Incorporating a standardized approach to warfarin management in the primary care setting significantly improves warfarin-related documentation and time in therapeutic INR range.

Implementation of a PARP helped increase pharmacist engagement through participation in quality-improvement and professional development activities. The program also led to the creation of organizationwide interprofessional guidelines for advancement programs within various healthcare disciplines.