Development of a Taxonomy for Medication-Related Patient Safety Events Related to Health Information Technology in Pediatrics

Abstract

Background Although electronic health records (EHRs) are designed to improve patient safety, they have been associated with serious patient harm. An agreed-upon and standard taxonomy for classifying health information technology (HIT) related patient safety events does not exist. Objectives We aimed to develop and evaluate a taxonomy for medication-related patient safety events associated with HIT and validate it using a set of events involving pediatric patients. Methods We performed a literature search to identify existing classifications for HIT-related safety events, which were assessed using real-world pediatric medication-related patient safety events extracted from two sources: patient safety event reporting system (ERS) reports and information technology help desk (HD) tickets. A team of clinical and patient safety experts used iterative tests of change and consensus building to converge on a single taxonomy. The final devised taxonomy was applied to pediatric medication-related events assess its characteristics, including interrater reliability and agreement. Results Literature review identified four existing classifications for HIT-related patient safety events, and one was iteratively adapted to converge on a singular taxonomy. Safety events relating to usability accounted for a greater proportion of ERS reports, compared with HD tickets (37 vs. 20%, p = 0.022). Conversely, events pertaining to incorrect configuration accounted for a greater proportion of HD tickets, compared with ERS reports (63 vs. 8%, p < 0.01). Interrater agreement (%) and reliability (kappa) were 87.8% and 0.688 for ERS reports and 73.6% and 0.556 for HD tickets, respectively. Discussion A standardized taxonomy for medication-related patient safety events related to HIT is presented. The taxonomy was validated using pediatric events. Further evaluation can assess whether the taxonomy is suitable for nonmedication-related events and those occurring in other patient populations. Conclusion Wider application of standardized taxonomies will allow for peer benchmarking and facilitate collaborative interinstitutional patient safety improvement efforts.

Classification of Electronic Health Record–Related Patient Safety Incidents: Development and Validation Study

“…The patient safety incident reporting system is fundamental to obtaining and processing patient safety-related information for improving work. Incident reporting aims to detect problems and investigate underlying causes; as a result, there is a possibility of using organizational learning to prevent such incidents from happening again [26][27][28][29].…”

“…However, this information is not shared frequently, so organizations are constantly reinventing the wheel to address EHR issues and improve functionality [2,31]. There is a concern that benefits from HIT-related safety data are lost because of the absence of a mechanism to classify HIT-related events; yet, it is not well established how to define and classify incidents in these systems [19,28,29]. It has been suggested that research evidence, testing, and development of classifications applicable specifically for high-maturity EHRs are needed [10][11][12]28].…”

Classification of Health Information Technology Safety Events in a Pediatric Tertiary Care Hospital

“…Furthermore, there is an overarching lack of classification systems and taxonomy regarding errors, which makes it more difficult for vendors to effectively gather information from multiple clients and promote change. 24,[28][29][30][31][32][33][34] Our analysis suggests the need to further study and develop systems and processes to improve the quality of the identification and reporting of HIT safety events. This includes improving the reporting system user interface for the end users who file the report and education and tools for the safety managers who review them.…”

“…This is because hospitals and vendors lack straightforward bidirectional channels for the sharing of information—hospitals are cautious regarding the sharing of data/screenshots/patient information, and vendors often do not have the infrastructure or feedback mechanisms in place to receive such information due to a multitude of reasons, including potential liability concerns, which could arise. Furthermore, there is an overarching lack of classification systems and taxonomy regarding errors, which makes it more difficult for vendors to effectively gather information from multiple clients and promote change 24,28–34 …”

Design of Intelligent Pediatric Nursing Management Platform from the Perspective of Big Data

“…Pan Li's experimental analysis shows that the application of teaching resource library in multimedia teaching of community nursing can effectively improve students' interest in learning and optimize the teaching effect [2]. Kirk D aims to develop and evaluate the classification of drug-related patient safety events related to HIT, and verify it with a set of events involving pediatric patients [3]. However, the application of big data in pediatric nursing management needs further promotion and research.…”