Ambulance Personnel Perceptions of Near Misses and Adverse Events in Pediatric Patients

Abstract

Objective-To identify Emergency Medical Services (EMS) provider perceptions of factors that may affect the occurrence, identification, reporting, and reduction of near misses and adverse events in the pediatric EMS patient.Methods-This was a subgroup analysis of a qualitative study examining the nature of near misses and adverse events in EMS as it relates to pediatric prehospital care. Complimentary qualitative methods of focus groups, interviews, and anonymous event reporting were used to collect results and emerging themes were identified and assigned to specific analytic domains.Results-Eleven anonymous event reports, 17 semi-structured interviews, and 2 focus groups identified 61 total events, of which 12 (20%) were child-related. Eight (66%) of those were characterized by participants as having resulted in no injury, 2 (16%) resulted in potential injury, and 2 (16%) involved an ultimate fatality. Three analytic domains were identified which included the following five themes: reporting is uncommon, blaming errors on others, provider stress/discomfort, errors of omission, and limited training. Among perceived causes of events, participants noted factors relating to management problems specific to pediatrics, problems with procedural skill performance, medication problems/calculation errors, improper equipment size, parental interference, and omission of treatment related to providers' discomfort with the patient's age. Few participants spoke about errors they had themselves committed; most discussions centered on errors participants observed being made by others.Conclusions-It appears that adverse events and near misses in the pediatric EMS environment may go unreported in a large proportion of cases. Participants attributed the occurrence of errors to the stress and anxiety produced by a lack of familiarity with pediatric patients and to a reluctance to cause pain or potential harm, as well as to inadequate practical training and experience in caring for the pediatric population. Errors of omission, rather than those of commission, were perceived to predominate. This study provides a foundation on which to base additional studies of both qualitative * Note: Dr. O'Gara is now with Rochester General Hospital, Rochester, NY, and Dr. Pennington is now with Boston University/Boston Medical Center Department of Surgery, Boston, MA. and quantitative nature that will shed further light on the factors contributing to the occurrence, reporting, and mitigation of adverse events and near misses in the pediatric EMS setting.

Analysis of reported e-prescribing near misses in King Saud Medical City, Riyadh

“…However, near misses are frequently underreported. 17,19,28 A variety of medicationrelated data, such as wrong dose frequency, wrong dose, wrong drug, wrong duration of drug use, wrong drug concentration, and wrong dosage forms, found in the present study are consistent with other reports. [29][30][31] Therefore, there should be electronic checks in the process of prescribing and dispensing medications in order to prevent medication errors and the adverse health consequences and economic losses involved.…”

“…However, there are substantial data on near misses in the Western world. [11][12][13][14][15][16][17][18][19][20][21] Near misses may occur in handwritten as well as electronic prescriptions. In the medical context, a near miss is a medication error that happened but did not reach the patient.…”

“…Other important observed sites where near misses were made were pediatric and adult emergency service settings and maternal ambulatory care services, which is consistent with other studies. [11][12]19,25 In general, multiple factors, including gender of patient, age, weight, diagnosis, prescribed medications, experience of health care providers, practice setting, and the presence or absence of an electronic prescribing system have a strong impact on the prevalence of medication errors. 9,10,24 Similar factors tend to predict the occurrence of near misses.…”

Comparison of Outcomes for Children With Cervical Spine Injury Based on Destination Hospital From Scene of Injury

“…[33][34][35] One study of EMS behavior suggests that fear of causing additional harm may create reluctance to administer medications. 36 A prior report of analgesia use in trauma patients in the ED setting found while overall 48% of patients received narcotics, use was less likely in children and patients with altered mental status or intubation. 37 Similarly in our data set, 47% of patients received analgesia but much fewer at the local hospitals than at the trauma centers.…”

Typische Probleme bei Kindernotfällen

“…In einer qualitativen Untersuchung in den USA wurden Rettungsassistenten befragt, die Faktoren zu Fehlern in der prä-klinischen Versorgung von pädiatrischen Patienten beitragen [6]. Berichtet wurden Schwierigkeiten durch: 5 technische Prozeduren/Fähigkeiten, 5 Medikamenten-/Dosierungsprobleme, 5 fehlendes oder nichtpassendendes Equipment, 5 elterliche Anwesenheit.…”