Adverse Events in Hospitalized Pediatric Patients

Stockwell, David C.; Landrigan, Christopher P.; Toomey, Sara L.; Loren, Samuel S.; Jang, Jisun; Quinn, Jessica; Ashrafzadeh, Sepideh; Wang, Michelle J.; Wu, Melody; Sharek, Paul J.; Classen, David C.; Srivastava, Rajendu; Parry, Gareth; Schuster, Mark A.

doi:10.1542/peds.2017-3360

Cited by 80 publications

(85 citation statements)

References 44 publications

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“…6,7,9 This is mostly due to the intricate process entailed by the preparation of drugs for newborn infants which, among other things, requires multiple dilutions, especially in the case of very small preterm infants. 10,22,30,31 M o r e o v e r , t h e s t u d i e s t h a t a n a l y z e d errors reported in hospitalized children at the Department of Pediatrics found that the rate of AEs at the NICU was higher than the rest 8,12,29,[34][35][36] and this was also observed in our study, where more than half of all AEs occurred at the NICU. The 3 severe AEs that occurred at the NICU corresponded to dosing errors: 1 in the physician's prescription and 2 due to drug dilution mistakes made by nurses.…”

Section: Discussionsupporting

confidence: 85%

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Voluntary and anonymous reporting of medication errors in patients admitted to the Department of Pediatrics

et al. 2019

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Objective. To assess reports of medication errors in hospitalized children to establish their frequency, causes, and adverse events(AEs). Methods. Prospective study of medication errors reported at the Neonatal Intensive Care Unit (NICU), Pediatric Clinic (PC), and Pediatric intensive Care Unit (PICU). Ambulatory Pediatrics reports and incomplete data were excluded. Related variables were evaluated. Results. Out of 989 errors reported in Department of Pediatrics, 401 (41 %) corresponded to medication errors. Of these, 353 (88 %) reached patients and 48 (12 %) were quasi-errors; 42 % occurred in the morning; 24 %, in the afternoon; 17 %, in the morning and afternoon, and 17 %, in the night; differences were not significant (p = 0.18). Dosing errors were the most common ones, 118 (33.4 %). In total, 160 reports (45 %) corresponded to prescription errors; 149 (42 %), to administration errors; and 44 (2.5 %), to dispensing errors. Dosing errors were more common in prescriptions (p < 0.05). The highest number of errors was reported at the NICU, 179 (50 %); compared to 91 (25.5 %) at the PC and 83 (24.5 %) at the PICU. A total of 91 AEs were reported (22.5 %); most were mild, 53 (58 %), or moderate, 31 (34 %). The NICU reported 53 AEs (58 %); the PICU, 25 (27 %); and the DCP, 18 (19.7 %). No deaths occurred. Conclusion. The rate of medication errors reported in hospitalized children was 41 %. Dosing errors were the most common ones. A total of 91 AEs were reported; most were mild (58 %); the highest number was reported at the NICU (58 %).

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Section: Discussionsupporting

confidence: 85%

“…This is a very relevant aspect because error prevention barriers are one of the most important measures in patient safety to reduce or avoid AEs. 9,10,25,27,[32][33][34][35]…”

Section: Discussionmentioning

confidence: 99%

Voluntary and anonymous reporting of medication errors in patients admitted to the Department of Pediatrics

et al. 2019

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“…Insurance status was documented in 3468 records with 19 030 patient days. As previously reported, 21 reviewers identified a total of 413 AEs (19.5 AEs per 1000 patient days; 95% confidence interval [CI]: 17.6-21.4) and 209 preventable AEs (9.9 AEs per 1000 patient days; 95% CI: 8.5-11.2) across the entire cohort of patients.…”

Section: Resultsmentioning

confidence: 89%

Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children

Stockwell

Landrigan

Toomey

et al. 2019

Hospital Pediatrics

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OBJECTIVES: Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. METHODS: GAPPS was applied to medical records of randomly selected pediatric patients discharged from 16 hospitals in the Pediatric Research in Inpatient Settings Network across 4 US regions from January 2007 to December 2012. Disparities in AEs for hospitalized children were identified on the basis of patient race/ethnicity (black, Latino, white, or other; N = 17 336 patient days) and insurance status (public, private, or self-pay/no insurance; N = 19 030 patient days). RESULTS: Compared with hospitalized non-Latino white children, hospitalized Latino children experienced higher rates of all AEs (Latino: 30.1 AEs per 1000 patient days versus white: 16.9 AEs per 1000 patient days; P ≤ .001), preventable AEs (Latino: 15.9 AEs per 1000 patient days versus white: 8.9 AEs per 1000 patient days; P = .002), and high-severity AEs (Latino: 12.6 AEs per 1000 patient days versus white: 7.7 AEs per 1000 patient days; P = .02). Compared with privately insured children, publicly insured children experienced higher rates of preventable AEs (public: 12.1 AEs per 1000 patient days versus private: 8.5 AEs per 1000 patient days; P = .02). No significant differences were observed among other groups. CONCLUSIONS: The GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings. Further investigation may reveal underlying mechanisms of these disparities and could help hospitals reduce harm.

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“…Certain paediatric populations have high healthcare utilization and may be exposed to increased risk . Children with Intellectual Disability (ID) are one such population, with emerging evidence which indicates that children with ID are particularly susceptible to avoidable harm in their care .…”

Section: Introductionmentioning

confidence: 99%

Partnerships for safe care: A meta‐narrative of the experience for the parent of a child with Intellectual Disability in hospital

Mimmo

Woolfenden

Travaglia

et al. 2019

Health Expectations

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Objective To systematically identify and synthesize peer‐reviewed qualitative evidence of the parental experience of hospitalization with a child with Intellectual Disability. Search strategy Key words, synonyms and MeSH subject headings that related to the three key concepts of parental experience, children with Intellectual Disability and hospital settings were applied to six electronic databases: Medline, CINAHL, Embase, PsycINFO, Scopus and Web of Science. Titles and abstracts of publications between January 2000 and February 2019 were screened for relevance. Inclusion criteria Empirical qualitative research involved participants aged 0‐18 years, involved children with Intellectual Disability, involved participants hospitalized as an in‐patient and involved participants focused on parent perspective. Data extraction and synthesis Data were extracted and synthesized using a meta‐narrative approach. Results Eleven publications met the inclusion criteria. Data synthesis revealed three research traditions contributing to this meta‐narrative: Paediatric Nursing Practice, Intellectual Disability Healthcare and Patient Experience. A total of five themes were identified: (a) being more than a parent, (b) importance of role negotiation, (c) building trust and relationships, (d) the cumulative effect of previous experiences of hospitalization and (e) knowing the child as an individual. Discussion and conclusion This review presents a working model for professional‐parent partnership for the safe care of children with Intellectual Disability in hospital. Shifting paediatric healthcare to whole of hospital/multidisciplinary models of care that centre on the child will necessitate partnerships with the parent to identify and manage the needs of the child with Intellectual Disability, in order to achieve safe and equitable care for these children.

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Adverse Events in Hospitalized Pediatric Patients

Abstract: AE rates in pediatric inpatients are high and did not improve from 2007 to 2012. Pediatric AE rates were substantially higher in teaching hospitals as well as in patients with more chronic conditions.

Cited by 80 publications

References 44 publications

Voluntary and anonymous reporting of medication errors in patients admitted to the Department of Pediatrics

Voluntary and anonymous reporting of medication errors in patients admitted to the Department of Pediatrics

Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children

Partnerships for safe care: A meta‐narrative of the experience for the parent of a child with Intellectual Disability in hospital

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