Effect of an Integrated Care Pathway on Acute Asthma/Wheeze in Children Attending Hospital: Cluster Randomized Trial

BACKGROUND AND OBJECTIVE: Medication errors cause appreciable morbidity and mortality in children. The objective was to determine the effectiveness of interventions to reduce pediatric medication errors, identify gaps in the literature, and perform meta-analyses on comparable studies. METHODS:Relevant studies were identified from searches of PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing Allied Health Literature and previous systematic reviews. Inclusion criteria were peer-reviewed original data in any language testing an intervention to reduce medication errors in children. Abstract and full-text article review were conducted by 2 independent authors with sequential data extraction.RESULTS: A total of 274 full-text articles were reviewed and 63 were included. Only 1% of studies were conducted at community hospitals, 11% were conducted in ambulatory populations, 10% reported preventable adverse drug events, 10% examined administering errors, 3% examined dispensing errors, and none reported cost-effectiveness data, suggesting persistent research gaps. Variation existed in the methods, definitions, outcomes, and rate denominators for all studies; and many showed an appreciable risk of bias. Although 26 studies (41%) involved computerized provider order entry, a meta-analysis was not performed because of methodologic heterogeneity. Studies of computerized provider order entry with clinical decision support compared with studies without clinical decision support reported a 36% to 87% reduction in prescribing errors; studies of preprinted order sheets revealed a 27% to 82% reduction in prescribing errors.CONCLUSIONS: Pediatric medication errors can be reduced, although our understanding of optimal interventions remains hampered. Research should focus on understudied areas, use standardized definitions and outcomes, and evaluate cost-effectiveness. Pediatrics

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“…Reduce prescribing errors for all patients Alagha, 30 Broussard, 32 Burmester, 35 Cimino, 1 Cunningham, 39 Dinning, 77 Kozer 2005, 55 Larose, 57 …”

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confidence: 99%

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

Rinke

Bundy

Velasquez³

et al. 2014

Pediatrics

134

119

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“…12 A clinical pathway can be an effective tool to increase uptake of evidencebased health care by pharmacists and other primary care professionals in the community, who care for the majority of patients with CKD. [13][14][15] Pharmacists in Canada have an expanding scope of practice; pharmacists can order laboratory tests, adapt new prescriptions, perform therapeutic substitutions, issue prescriptions for continuity of care and prescribe in emergency situations. 16 In Alberta, pharmacists who have Additional Prescribing Authorization can prescribe at initial access or manage ongoing therapy based on their own assessment or in collaboration with another regulated health care professional.…”

Section: Introductionmentioning

confidence: 99%

Online clinical pathway for managing adults with chronic kidney disease

et al. 2015

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“…[7][8][9][10][11] There is growing evidence for CP effectiveness, including improved safety, quality, cost savings and other efficiencies. [14][15][16][17][18][19][20][25][26][27] Most pediatric CP studies reporting positive outcomes were done in single pediatric institutions where implementation may have been less challenging. Negative CP trials typically result from incomplete implementation.…”

Section: Discussionmentioning

confidence: 99%

Evidence based pediatric care closer to home: A mixed methods evaluation of a clinical pathways-based emergency outreach program

Jabbour

Reid

Irwin

et al. 2017

JHA

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Objective: While specialized pediatric care is not feasible in all Emergency Department (ED) settings, enhanced system capacity is needed to appropriately address pediatric emergency care needs. Our objective was to evaluate an innovative clinical pathway (CP) based regional ED outreach program within community EDs. Methods: This mixed-methods design includes pre/post chart audits, qualitative interviews, ED site audits, and website utilization metrics. The study was conducted in community-based hospital EDs within the region. ED nurses, physicians and administrators from eight hospitals participated in the study. The ED outreach program involved implementation of 3 CPs addressing common pediatric emergency presentations: asthma, croup and gastroenteritis. Primary outcomes from chart audits included presence of a CP-related document filed in relevant patient charts and the proportion of patients who received appropriate care as per the severity-based CP recommendations. Secondary outcomes included documented assessments of condition severity, use of specific treatments and hospital metrics. Results: ED health professionals value the outreach initiative and CPs. Site audits confirmed ED presence and knowledge of CP tools. However several adoption barriers were identified, including time, perceived threats to physician autonomy and infrequent opportunities for use. Chart audits demonstrated site-dependent, variable uptake of CP resources into ED workflows. In total, 1,274 health records were audited, with the following pre/post breakdowns: 203/211 (asthma), 131/193 (croup) and 291/245 (gastroenteritis). We could not evaluate our primary outcomes due to infrequent documentation of condition severity. Significant post-implementation improvements were demonstrated in gastroenteritis management. Median length of stay remained unchanged (asthma) or increased (croup, gastroenteritis). ED site was an important predictor of some asthma treatments and LOS for asthma (p < .001), croup (p = .01) and gastroenteritis (p < .001). Conclusions: CP documents were available in EDs, but may not be utilized as fully intended. Site heterogeneity may account for lack of significant change in several outcome variables.

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Effect of an Integrated Care Pathway on Acute Asthma/Wheeze in Children Attending Hospital: Cluster Randomized Trial

Cited by 86 publications

References 21 publications

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

Online clinical pathway for managing adults with chronic kidney disease

Evidence based pediatric care closer to home: A mixed methods evaluation of a clinical pathways-based emergency outreach program

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