Prevalence of adverse events in pediatric intensive care units in the United States*

Agarwal, Swati; Classen, David C.; Larsen, Gitte; Tofil, Nancy M.; Hayes, Leslie; Sullivan, Janice E.; Storgion, Stephanie A.; Coopes, Barbara J.; Craig, Vicki; Jaderlund, Christine; Bisarya, Hema; Parast, Layla; Sharek, Paul J.

doi:10.1097/pcc.0b013e3181d8e405

Cited by 143 publications

(153 citation statements)

References 35 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…Consistent with earlier trigger-based harm detection studies, nearly one half of the harm was deemed preventable. 2,13,14 One of every 4 pediatric admissions in our study had at least 1 identified harm. Our detected harm rate is similar to a recent single-site study, which detected a pediatric harm rate of 37 harm events for every 100 admissions using the adultfocused IHI GTT.…”

Section: Discussionmentioning

confidence: 99%

“…20 Any patients who were admitted for rehabilitation, to the normal newborn nursery, to day treatment areas, or with a primary discharge diagnosis related to psychiatric or obstetric care were excluded as is consistent with earlier study designs. [12][13][14][15][16][17] A random sample of 100 patients who met the inclusion criteria was selected from each site for review. Institutional review board waiver or approval for this study was granted at each site.…”

Section: Design Setting and Patientsmentioning

confidence: 99%

“…2,[6][7][8][9][10][11] These efforts have reinforced the perspective that the trigger tool approach is at present the most reliable and consistent harm detection method. 3,7,10 Although the IHI GTT was designed for the adult population, 1 children's hospital tested it on its pediatric inpatient records and identified [13][14][15][16][17] However, a single, pediatric-specific detection tool that can be applied across all settings, analogous to the IHI's GTT, has not been available. Until a comprehensive standard harm measure is established in pediatrics, improvement efforts will continue to focus on a fraction of the harm that occurs to patients, leaving countless harms within the system unrecognized and unaddressed.…”

mentioning

confidence: 99%

See 2 more Smart Citations

A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

et al. 2015

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: An efficient and reliable process for measuring harm due to medical care is needed to advance pediatric patient safety. Several pediatric studies have assessed the use of trigger tools in varying inpatient environments. Using the Institute for Healthcare Improvement’s adult-focused Global Trigger Tool as a model, we developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatric inpatient environments. METHODS: After formal training, 6 academic children’s hospitals used this novel pediatric trigger tool to review 100 randomly selected inpatient records per site from patients discharged during the month of February 2012. RESULTS: From the 600 patient charts evaluated, 240 harmful events (“harms”) were identified, resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals. At least 1 harm was identified in 146 patients (24.3% of patients). Of the 240 total events, 108 (45.0%) were assessed to have been potentially or definitely preventable. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications. CONCLUSIONS: Consistent with earlier rates of all-cause harm in adult hospitals, harm occurs at high rates in hospitalized children. Availability and use of an all-cause harm identification tool will establish the epidemiology of harm and will provide a consistent approach to assessing the effect of interventions on harms in hospitalized children.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Design Setting and Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Similar to those focused on adult populations, pediatricfocused trigger tools have been found to be more efficient and effective at identifying harms compared with traditional methods. [9][10][11][12][13][14] Trigger tool-derived harm rates in the pediatric population have ranged from 11 drug-related harms per 100 patients in the pediatric acute care environment to 203 all-cause harms per 100 patients in the pediatric ICU. 12,14 Our ability to successfully pursue and demonstrate reduction of all-cause harm in pediatric inpatients will require having an efficient and reliable process for harm identification that can be implemented across disparate sites.…”

mentioning

confidence: 99%

“…[9][10][11][12][13][14] Pediatric-focused trigger tools have been created for the neonatal intensive care unit (ICU), the pediatric ICU, and the general pediatric inpatient environments as harm detection tools. Similar to those focused on adult populations, pediatricfocused trigger tools have been found to be more efficient and effective at identifying harms compared with traditional methods.…”

mentioning

confidence: 99%

Development of an Electronic Pediatric All-Cause Harm Measurement Tool Using a Modified Delphi Method

et al. 2016

Self Cite

View full text Add to dashboard Cite

Application of a modified Delphi method on an expert-constructed list of 108 triggers, focusing on severity and frequency of harms as well as detectability of triggers in an electronic medical record, resulted in a final list of 51 pediatric triggers. Pilot testing this list of pediatric triggers to identify all-cause harm for pediatric inpatients is the next step to establish the appropriateness of each trigger for inclusion in a global pediatric safety measurement tool.

show abstract

Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis

Maaskant

Tio

Hest

et al. 2018

Health Science Reports

View full text Add to dashboard Cite

Objective: Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children. Method:We performed an interrupted time series analysis with 6 preintervention and 6 postintervention data collection points, in a tertiary pediatric intensive care unit. We included intensive care patients admitted during July to December 2013 (preintervention) and July to December 2014 (postintervention). The primary endpoint was the prevalence of MEs per 100 prescriptions. We reviewed the clinical records of the patients and the incident reporting system for MEs. If an ME was suspected, a pediatrician-intensivist and a clinical pharmacist determined causality and preventability. They classified MEs as harmful according to the National Coordinating Council for Medication Error Reporting and Prevention categories. Results:We included 254 patients in the preintervention period and 230 patients in the postintervention period. We identified 153 MEs in the preintervention period, corresponding with 2.27 per 100 prescriptions, and 90 MEs in the postintervention period, corresponding with 1.71 per 100 prescriptions. Autoregressive integrated moving average analyses revealed a significant change in slopes between the preintervention and postintervention periods (β = −.21; 95% CI, −0.41 to −0.02; P = .04). We did not observe a significant decrease immediately after the start of the intervention (β = −.61; 95% CI, −1.31 to 0.08; P = .07). Conclusion:The implementation of a structured medication audit, followed by feedback by a clinical pharmacist as part of the multidisciplinary team, resulted in a significant reduction of MEs in a tertiary pediatric intensive care unit. KEYWORDSharm, ITS, medication error, multifaceted intervention, pharmacist, PICU Because of the growing awareness of the complexity of the medication process and medication safety issues, it has been suggested that active involvement of a clinical pharmacist on pediatric wards might be of additional value. Three systematic reviews report a reduction of MEs after a pharmacist was employed on clinical wards, but the included studies do not provide a clear description of the interventions by the clinical pharmacist. [10][11][12] In addition, quality issues arise as most of the included publications involved observational studies, before-and-after designs were without a control group, or the MEs were self-reported by the intervening pharmacist. 10-12 A recentCochrane systematic review 13 included only 1 high-quality, controlled before-after study that showed a significant reduction of serious MEs after the implementation of a multifaceted intervention by a full-time clinical pharmacist on a PICU.14 Since available evidence is scarce, we decided to study the effect of a structure...

show abstract

Prevalence of adverse events in pediatric intensive care units in the United States*

Abstract: AEs and ADEs occur frequently in the PICU setting. These data provide areas of focus for evidence-based prevention strategies to decrease the substantial risk to this vulnerable pediatric population.

Cited by 143 publications

References 35 publications

A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

Development of an Electronic Pediatric All-Cause Harm Measurement Tool Using a Modified Delphi Method

Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis

Contact Info

Product

Resources

About