Safety in Children With Medical Complexity: Our Canaries in the Coal Mine?

Schindler, Christine A.; Pordes, Elisabeth; Finkenbinder, Steven D.; Lee, K. Jane

doi:10.1007/s40746-019-00159-2

Cited by 10 publications

(7 citation statements)

References 79 publications

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“…It must be strongly emphasized that, precisely by virtue of these characteristics, these children highlight the vulnerabilities of our approach to the cures: fragmented and often inefficient [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The child with medical complexity

et al. 2021

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Children with medical complexity represent a big challenge for the physicians, their families and the society as well. Although there is no clear definition of this type of patients, they are affected by a chronic, often very severe condition for their whole life. They also represent a huge cost for the health care system due to their needs of continuous assistance.In this review we summarized the definitions of child with medical complexity. Then we illustrated the strategies to treat and take care of these children in order to look at them not as a burden or a cost but as an opportunity to growth and improve as clinicians and to improve the society, to give them the best life they can live.We also wanted to give voice to the physicians, the parents and the children themselves to really show and understand what are their experiences and their feelings in dealing with their conditions. We concluded with the description of one example of children with medical complexity: prematurity. We discussed the progresses in their treatment so far in order to illustrate what is the future of pediatrics. Since it has been more and more acknowledged that every child with medical complexity is unique, the future of pediatric is to organize an individualized approach and to “see things with the eye of a child”.

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Section: Introductionmentioning

confidence: 99%

The child with medical complexity

et al. 2021

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“…Even outside of compounding, pediatric prescription errors are not uncommon and may be the result of calculation errors, using the total daily dose instead of dividing into recommended frequencies, volume-based instead of mass-based doses, and lack of patient weight information needed for dose validation, among others [19,20]. Children, especially CMC, therefore, often face more health and safety risk as a result of complex care needs than as a result of their illness itself [21]. As a science-based, standards-setting organization, USP is well-positioned to address such an important healthcare system need.…”

Section: Discussionmentioning

confidence: 99%

Minimizing Medication Errors from Electronic Prescription Transmission—Digitizing Compounded Drug Preparations

et al. 2019

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Lack of standardization related to compounded drug preparations, especially in the transition of care situations, threatens patient safety by facilitating medication error. This paper outlines progress to-date from the United States Pharmacopeia (USP) Expert Panel on the Exchange of Compounded Drug Preparation Information in Health IT Systems. The work plan developed for the group is focused on proposing a set of encoding rules that would govern how compounded nonsterile drug preparations (CNSPs) are digitized and exchanged, including patient electronic health records (EHR), pharmacy systems, e-prescribing (eRx), and other Health IT (HIT) systems to ensure a seamless compounding process tailored to the needs of an individual patient. Included in this work are identifying authorized compounding monographs, surveying provider and end-user groups for information about data specificity during e-prescribing, and generating guidelines for the development of a compatible data model for clinical formulation identifiers (CF-IDs). This paper will also discuss how evolving nomenclature standards for CNSPs within HIT systems are part of a quality assurance system for comprehensive medication management (CMM) in children, thereby minimizing medication errors across the continuum of care. Finally, a network approach for the design of medication management systems for children and their families/caregivers is proposed.

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“…Challenges with communication and data-gathering for children and youth with neurologic impairment may contribute to risk of diagnostic error and harm. Disparities in access to care may also impact safety, with children with developmental disabilities less likely to receive care in a medical home and the benefits of care coordination and preventative care including immunizations [57,58].…”

Section: Medical Complexitymentioning

confidence: 99%

“…In one study of children with cancer, almost half had been exposed to at least one medication error in the home [ 15 ]. Safety risks and the high prevalence of unmet care needs faced by children with medical complexity have been attributed in particular to the complex nature of care delivery [ 57 ]. Children with medical complexity have increased healthcare utilization [ 45 ], and more frequent transitions between care settings may increase opportunity for care fragmentation and error.…”

Section: Contextual Factorsmentioning

confidence: 99%

Patient Safety in Ambulatory Pediatrics

Huth

Hotz

Starmer

2020

Curr Treat Options Peds

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Purpose of Review The majority of patient care occurs in the ambulatory setting, and pediatric patients are at high risk of medical error and harm. Prior studies have described various safety threats in ambulatory pediatrics, and little is known about effective strategies to minimize error. The purpose of this review is to identify best practices for optimizing safety in ambulatory pediatrics. Recent Findings The majority of the patient safety literature in ambulatory pediatrics describes frequencies and types of medical errors. Study of effective interventions to reduce error, and particularly to reduce harm, have been limited. There is evidence that medical complexity and social context are important modifiers of risk. Telemedicine has emerged as a care delivery model with potential to ameliorate and exacerbate safety threats. Though there is variation across studies, developing a safety culture, partnerships with patients and families, and use of structured communication are strategies that support patient safety. Summary There is no standardized taxonomy for errors in ambulatory pediatrics, but errors related to medications, vaccines, diagnosis, and care coordination and care transitions are commonly described. Evidence-based approaches to optimize safety include standardized prescribing and medication reconciliation practices, appropriate use of decision support tools in the electronic health record, and communication strategies like teach-back. Further high-quality intervention studies in pediatric ambulatory care that assess impact on patient harm and clinical outcomes should be prioritized. Patient Safety (Ma Coffey, Section Editor) Medication errors Wrong drug prescribed or administered Wrong dose prescribed or administered Wrong route prescribed or administered Wrong frequency or duration prescribed or administered Omitted or duplicated dose Drug-drug interaction Known allergy Vaccine errors Wrong timing of vaccine Wrong route of administration Storage and dispensing errors Wrong vaccine administered Diagnostic errors Errors in the evaluation of signs and symptoms Errors in follow-up of diagnostic tests Errors related to missed, incorrect or delayed diagnoses Misfiled or erroneously entered patient information Lack of consent for an adult accompanying a child Delay in office care Wrong patient registered or treated Care coordination and care transition errors Verbal or written handoff communication failure Coordination errors including delayed access to medications, medical equipment and supplies Patient Safety in Ambulatory Pediatrics Huth et al.

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Safety in Children With Medical Complexity: Our Canaries in the Coal Mine?

Cited by 10 publications

References 79 publications

The child with medical complexity

The child with medical complexity

Minimizing Medication Errors from Electronic Prescription Transmission—Digitizing Compounded Drug Preparations

Patient Safety in Ambulatory Pediatrics

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