Medical Errors in US Pediatric Inpatients With Chronic Conditions

Ahuja, Namrata; Zhao, Weiyan; Xiang, Hao

doi:10.1542/peds.2011-2555

Cited by 35 publications

(37 citation statements)

References 19 publications

(32 reference statements)

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“…These risk factors, present in more than 60% of our cohort, are a proxy for medical complexity. Children with special medical needs or dependence on medical technologies have significantly higher rates of hospital-reported medical errors(26) and as was also noted in our study, an increased number of chronic conditions is associated with medical errors in pediatric inpatients (27). …”

Section: Discussionsupporting

confidence: 82%

Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care

DeCourcey

Silverman

Chang

et al. 2017

Pediatric Critical Care Medicine

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Objectives Although medication reconciliation has become standard during hospital admission, rates of unintentional medication discrepancies during intensive care of pediatric patients with chronic disease are unknown. Such discrepancies are an important cause of adverse drug events in adults with chronic illness and are associated with unintentional discontinuation of chronic medications. We sought to determine the rate, type, timing and predictors of potentially harmful unintentional medication discrepancies in children and young adults with chronic disease. Design Prospective observational cohort study. Setting Patients discharged from the Intensive and Intermediate Care Units at a tertiary care children’s hospital from September 2013–May 2014. Patients Consecutive sample of 308 patients less than 25 years of age with chronic disease defined by prescription of at least one predetermined class of chronic medication prior to hospitalization. Measurements and Main Results The number of unintentional medication discrepancies with the potential for harm, as well as patient and medication-related factors predisposing patients to these errors were assessed. 2739 medication discrepancies were identified; 284 (10%) were unintentional and had the potential for harm (0.9 per patient). Of these, 128 (45%) were due to errors in taking the preadmission medication history, while 156 (55%) were due to errors reconciling the medication history with orders. Most events occurred on admission (66%) and were dosing errors (45%). In multivariable negative binomial regression analyses (adjusted rate ratios [95% CI]), each additional preadmission medication (1.07 [1.04–1.10]), chronic respiratory medications (1.51 [1.01–2.28]) and chronic non-invasive ventilation (1.53 [1.07–2.19]) were associated with increased risk of a discrepancy. Conclusion Unintentional medication discrepancies with the potential for harm are common among children and young adults with chronic disease during critical care admission due to both failure to obtain an accurate medication history and errors in reconciling the history with patient orders. The use of current medication reconciliation processes is insufficient to prevent errors in this high risk population.

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Section: Discussionsupporting

confidence: 82%

Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care

DeCourcey

Silverman

Chang

et al. 2017

Pediatric Critical Care Medicine

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“…Specifically, paediatric patients more commonly encounter malpractice . Our study also indicates that nurses working in the children's hospital made medical errors most frequently, and that they have a high tendency for medical errors, particularly in the sub‐domains of drug administration, patient follow‐up and prevention of infections.…”

Section: Discussionmentioning

confidence: 59%

Malpractic in nursing: The experience in Turkey

Karadağ

Ovayolu

Kılıç

et al. 2014

Int J of Nursing Practice

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This cross-sectional study was conducted with 562 nurses to find out nurses' opinions and practices concerning medical errors and to measure their tendency to make medical mistakes. Data were collected using a questionnaire and Tendency for Medical Errors Scale and evaluated using Student's t and one-way ANOVA tests. The average total score of the participating nurses was 4.4 ± 0.3. It was observed that 36.1% nurses made medical errors, and all of those nurses making mistakes have stated that they have made medication errors. It was found that nurses with higher education and working in the intensive care unit had a lower tendency, whereas those working in children's hospital had a higher tendency to make medical mistakes (P < 0.05). It might be recommended that the working conditions of nurses be improved, and nurses in general and particularly, those working with pediatric patients be given regular training to prevent drug administration errors.

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“…9 Certain medical complications are more likely when children are in the hospital or longterm inpatient facilities rather than in an appropriately supervised home care setting. 10 States and payers are, at times, working together to build new models of care designed to contain cost and improve quality. However, most of these delivery reforms and the standards associated with them concentrate on adults with chronic conditions and not on children.…”

Section: Problem Statementmentioning

confidence: 99%

Financing of Pediatric Home Health Care

Simpser

Hudak

2017

Pediatrics

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Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrictions on benefits. As a result, home care responsibilities assumed by family caregivers have increased and imposed financial, physical, and psychological burdens on the family. The Patient Protection and Affordable Care Act set forth 10 mandated essential health benefits. Home care should be considered as an integral component of the habilitative and rehabilitative services and devices benefit, even though it is not explicitly recognized as a specific category of service. Pediatric-specific home health care services should be defined clearly as components of pediatric services, the 10th essential benefit, and recognized by all payers. Payments for home health care services should be sufficient to maintain an adequate provider work force with the pediatric-specific expertise and skills to care for children with medical complexity or developmental disability. Furthermore, coordination of care among various providers and the necessary direct patient care from which these care coordination plans are developed should be required and enabled by adequate payment. The American Academy of Pediatrics advocates for high-quality care by calling for development of pediatric-specific home health regulations and the licensure and certification of pediatric home health providers.

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Medical Errors in US Pediatric Inpatients With Chronic Conditions

Cited by 35 publications

References 19 publications

Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care

Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care

Malpractic in nursing: The experience in Turkey

Financing of Pediatric Home Health Care

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