Medication Errors Among Acutely Ill and Injured Children Treated in Rural Emergency Departments

Marcin, James P.; Dharmar, Madan; Cho, Meyng; Seifert, L.; Cook, Jenifer L.; Cole, Stacey L.; Nasrollahzadeh, Farid; Romano, Patrick S.

doi:10.1016/j.annemergmed.2007.01.020

Cited by 66 publications

(68 citation statements)

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“…[3][4][5][6]8,11,13 Our finding of lower physician-related ED medication errors among patients who received telemedicine consultations could be attributed to the specialized training and higher level of experience among the consulting physicians in treating children, which is consistent with other studies evaluating the impact of physician training and experience on patient outcomes. 8,15,[30][31][32][33] Kozer et al, 8 who examined medication errors experienced by children in an ED, found that trainees who do not have sufficient experience in treating children are more likely to commit prescribing errors than attending physicians. 8 Charash et al 30 examined the impact of telemedicine on simulated rural trauma patients in a moving ambulance and found that telemedicine resulted in better assessments, more interventions, and better patient outcomes Telemedicine consultations were associated with significantly fewer physician-related medication errors than telephone consultations, consistent with other intervention studies aimed at preventing medical errors in children.…”

Section: Discussionmentioning

confidence: 99%

“…2,6,9,[12][13][14] In previous work, we reported high frequencies of medication errors among children treated in rural EDs. 15 Others have found more frequent medication errors among children treated by trainees than among children treated by pediatric attending physicians. 8,16 These findings can be partially attributed to the level of experience and specialized training of physicians and staff caring for seriously ill and injured children.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

“…15 This instrument evaluated all medications administered in the ED. The medication error instrument was applied to all medical records independently by two pediatric pharmacists who were not involved in the care of the study participants, according to previously published guidelines.…”

Section: Medication Error Ascertainmentmentioning

confidence: 99%

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Telemedicine Consultations and Medication Errors in Rural Emergency Departments

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors. WHAT THIS STUDY ADDS:The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. abstract OBJECTIVE: To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs). METHODS:We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children' s hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level. RESULTS:Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs 10.8% and 12.5%, respectively; P , .05). In hierarchical logistic regression analysis, medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P , .05) or no consultations (odds ratio: 0.13, P , .05).CONCLUSIONS: Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.

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Section: Discussionmentioning

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Telemedicine Consultations and Medication Errors in Rural Emergency Departments

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“…Estudo realizado com objetivo de avaliar a incidência e a origem dos erros de medicação entre crianças atendidas em quatro unidades de emergência evidenciou 84 erros nos prontuários dos 182 pacientes selecionados para estudo, Rev Bras Enferm, Brasília 2011 mai-jun; 64(3): 563-9. resultando em taxa de 39% de erros. Apesar do índice elevado, não foram identificados danos aos pacientes (38) . Pesquisadores analisaram retrospectivamente os prontuários de 1532 crianças atendidas no setor de emergência de um hospital pediátrico de nível terciário do Canadá.…”

Section: Erros De Medicação Em Unidades De Emergência Pediátricaunclassified

“…Evidencia-se discussão quanto ao uso racional de medicamentos na comunidade que, segundo a OMS, se caracteriza pelo uso apropriado do medicamento conforme as condições clínicas do paciente, em doses adequadas às suas necessidades individuais, por um período adequado e ao menor custo para o paciente e para a comunidade (48) . O uso inadequado de medicamentos é considerado um problema de saúde pública (2,38) . A OMS estima que 50% de todos os medicamentos são prescritos, dispensados ou usados inadequadamente (49) .…”

Section: Erros De Medicação Na Comunidadeunclassified

Erros de medicação em pediatria

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Peterlini

2011

Rev. Bras. Enferm.

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RESUMOA segurança do paciente constitui problema de saúde pública, e erros com medicamentos são os mais freqüentes e graves. O artigo apresenta características epidemiológicas dos erros de medicação em diferentes áreas de atendimento pediátrico, e aponta estratégias de prevenção. Aproximadamente 8% das pesquisas sobre erros de medicação identificadas em bases de dados nacionais e internacionais referem-se à população pediátrica. Crianças apresentam maior vulnerabilidade à ocorrência de erros devido a fatores intrínsecos, destacando-se características anatômicas e fisiológicas; e extrínsecos, relativos à falta de políticas de saúde e da indústria farmacêutica voltadas ao atendimento de tais especificidades. As evidências apontam para a necessidade de implementação de estratégias de prevenção de erros de medicação, contribuindo para promover a segurança do paciente. descritores: Erros de medicação; Pediatria; Segurança; Qualidade da Assistência à Saúde. ABSTRACT Concerns regarding patient safety affect healthcare, and medication errors are the most frequent category of medical errors and linked with severe consequences. This study discusses epidemiologic characteristics of medication errors in pediatric patients and points out prevention strategies. Approximately 8% of the studies on the subject of medication errors identified in different national and international databases are distinctively related to the pediatric population. Children are vulnerable to medication errors due to intrinsic factors, such as proper anatomic and physiological characteristics; and due to extrinsic factors, with emphasis on the lack of public health politics and changes in the pharmaceutical industry to attend children's needs. The available evidences indicate, as imperative, the implementation of strategies to prevent medication errors, contributing to promote patient safety. Key words: Medication errors; Pediatric; Safety; Quality of Health Care. RESUMEN La seguridad del paciente es un problema de salud pública y los errores con medicamentos son los más frecuentes y más graves. Este artículo describe características epidemiológicas de errores de medicación en áreas de atención pediátrica y algunas estrategias de prevención. Aproximadamente 8% de las investigaciones sobre errores de medicación identificadas en las bases de datos nacionales e internacionales se refieren específicamente a niños. Los niños tienen mayor vulnerabilidad a la ocurrencia de errores debidos a factores intrínsecos, con destaque para características anatómicas y fisiológicas, e extrínsecos, en particular con respecto a falta de políticas sanitarias y de la industria farmacéutica orientada a la atención de tales características. Evidencias muestran la necesidad de aplicar estrategias para prevenir errores de medicación, promoviendo la seguridad del paciente. descriptores: Errores de medicación; Pediatría; Seguridad; Calidad de la Atención de Salud. erros de medicação em Pediatria

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Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers

et al. 2023

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ImportancePediatric referral centers are increasingly using telemedicine to provide consultations to help care for acutely ill children presenting to rural and community emergency departments (EDs). These pediatric telemedicine consultations may help improve physician decision-making and may reduce the frequency of overtriage and interfacility transfers.ObjectiveTo examine the use of pediatric critical care telemedicine vs telephone consultations associated with risk-adjusted transfer rates of acutely ill children from community and rural EDs.Design, Setting, and ParticipantsA cluster-randomized crossover trial was conducted between November 18, 2015, and March 26, 2018. Analyses were conducted from January 19, 2018, to July 23, 2022, 2022. Participants included acutely ill children aged 14 years and younger presenting to a participating ED in 15 rural and community EDs in northern California.InterventionsParticipating EDs were randomized to use telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine:1 telephone) crossover treatment assignment sequences.Main Outcomes and MeasuresIntention-to-treat, treatment-received, and per-protocol analyses were performed to determine the risk of transfer using mixed effects Poisson regression analyses with random intercepts for presenting EDs to account for hospital-level clustering.ResultsA total of 696 children (392 boys [56.3%]; mean [SD] age, 4.2 [4.6] years) were enrolled. Of the 537 children (77.2%) assigned to telemedicine, 251 (46.7%) received the intervention. In the intention-to-treat analysis, patients assigned to the telemedicine arm were less likely to be transferred compared with patients assigned to the telephone arm after adjusting for patient age, severity of illness, and hospital study period (risk rate [RR], 0.93; 95% CI, 0.88-0.99). The adjusted risk of transfer was significantly lower in the telemedicine arm compared with the telephone arm in both the treatment-received analysis (RR, 0.81; 95% CI, 0.71-0.94) and the per-protocol analysis (RR, 0.79; 95% CI, 0.68-0.92).Conclusions and RelevanceIn this randomized trial, the use of telemedicine to conduct consultations for acutely ill children in rural and community EDs resulted in less frequent overall interfacility transfers than consultations done by telephone.Trial RegistrationClinicalTrials.gov Identifier: NCT02877810

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Medication Errors Among Acutely Ill and Injured Children Treated in Rural Emergency Departments

Cited by 66 publications

References 21 publications

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

Erros de medicação em pediatria

Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers

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