Pediatric medication safety considerations for pharmacists in an adult hospital setting

2019 ◽  
Vol 76 (19) ◽  
pp. 1481-1491
Author(s):  
Audrey R Kennedy ◽  
Lindsay R Massey
Keyword(s):  
Medication Safety ◽  
Pediatric Patients ◽  
Risk Mitigation ◽  
Medication Use ◽  
Hospital Setting ◽  
Early Career ◽  
Mitigation Strategies ◽  
External Resources ◽  
Use Of Technology ◽  
Safety Considerations

Abstract Purpose Risks and vulnerabilities of the medication-use process in nonpediatric institutions that also serve pediatric patients are reviewed, and guidance on risk mitigation strategies is provided. Summary There are many risks and vulnerabilities in the medication-use process as it relates to pharmacotherapy for pediatric patients admitted to adult institutions. Mitigation of these risks is critical and should encompass various available resources and strategies. Special emphasis should be placed on use of technology to improve overall safety. Available literature recommends optimization of technology and resource use, institutional support for pediatric pharmacists’ involvement in managing pediatric medication use, and provision of early exposure to pediatric patients in pharmacist training programs as additional methods of mitigating risks associated with pediatric medication use in adult institutions. Adult hospitals that provide care for pediatric patients should assess their processes in order to identify hospital-specific interventions to promote pediatric medication safety. Conclusion Pediatric medication safety frameworks in U.S. adult institutions vary widely. Treating pediatric patients involves risks in all areas of the medication-use process. Optimizing technology, utilizing external resources, supporting a pediatric pharmacist, and providing early-career exposure to pediatric patients are methods to mitigate risks in institutions that primarily serve adult patients.

scholarly journals Use of failure modes and effects analysis to mitigate potential risks prior to implementation of an intravenous compounding technology

2021 ◽  
Author(s):  
Agnes Ann Feemster ◽  
Melissa Augustino ◽  
Rosemary Duncan ◽  
Anand Khandoobhai ◽  
Meghan Rowcliffe
Keyword(s):  
Medication Safety ◽  
Failure Modes ◽  
Risk Mitigation ◽  
New Technology ◽  
Hazard Index ◽  
Mitigation Strategies ◽  
Investigational Drug ◽  
Workflow Optimization ◽  
Proactive Approach ◽  
Risk Mitigation Strategies

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to identify potential failure points in a new chemotherapy preparation technology and to implement changes that prevent or minimize the consequences of those failures before they occur using the failure modes and effects analysis (FMEA) approach. Methods An FMEA was conducted by a team of medication safety pharmacists, oncology pharmacists and technicians, leadership from informatics, investigational drug, and medication safety services, and representatives from the technology vendor. Failure modes were scored using both Risk Priority Number (RPN) and Risk Hazard Index (RHI) scores. Results The chemotherapy preparation workflow was defined in a 41-step process with 16 failure modes. The RPN and RHI scores were identical for each failure mode because all failure modes were considered detectable. Five failure modes, all attributable to user error, were deemed to pose the highest risk. Mitigation strategies and system changes were identified for 2 failure modes, with subsequent system modifications resulting in reduced risk. Conclusion The FMEA was a useful tool for risk mitigation and workflow optimization prior to implementation of an intravenous compounding technology. The process of conducting this study served as a collaborative and proactive approach to reducing the potential for medication errors upon adoption of new technology into the chemotherapy preparation process.

scholarly journals Medication Safety

2020 ◽  
pp. 435-453
Author(s):  
Hooi Cheng Soon ◽  
Pierangelo Geppetti ◽  
Chiara Lupi ◽  
Boon Phiaw Kho
Keyword(s):  
Medication Errors ◽  
Medication Safety ◽  
Risk Mitigation ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Mitigation Strategies ◽  
Transitions Of Care ◽  
Patient Morbidity ◽  
Risk Mitigation Strategies ◽  
Core Areas

AbstractPharmacotherapy is the most common therapeutic intervention in healthcare to improve health outcomes of patients. However, there are many instances where prescribed medications resulted in patient morbidity and mortality instead. Medication errors can happen at any step of the medication use process, but a substantial burden of medication-related harm is focused primarily on three priority areas of healthcare delivery: transitions of care, polypharmacy and high-risk situations. This chapter highlights prevalence of issues concerning these three core areas and describes common medication errors as well as risk mitigation strategies to improve service delivery. An appreciation of these inherent risks will enable healthcare providers to navigate the pitfalls better and make efforts to ensure medication safety while providing health services.

Proactive Actions Based on a Resilient Approach to Urban Seismic Risk Mitigation

2020 ◽  
Vol 14 (1) ◽  
pp. 321-335
Author(s):  
Marco Vona
Keyword(s):  
Urban Planning ◽  
Emergency Management ◽  
Seismic Risk ◽  
Risk Mitigation ◽  
Housing Stock ◽  
Mitigation Strategies ◽  
Housing System ◽  
Management Tools ◽  
Natural Risk ◽  
Seismic Risk Mitigation

Background: Seismic risk mitigation is an important issue in earthquake-prone countries, and needs to be solved in those complex communities governed by complex processes, where urban planning, socioeconomic dynamics, and, often, the need to preserve cultural assets are present simultaneously. In recent years, due to limited financial resources, mitigation activities have often been limited to post-earthquake events, and only a few in periods of inactivity, particularly in urban planning. At this point, a significant change in point of view is necessary. Methods: The seismic risk mitigation (and more generally, natural risk mitigation) must be considered as the main topic in urban planning and in the governance of communities. In fact, in several recent earthquakes, significant socioeconomic losses have been caused by the low or lack of resilience of the communities. This is mainly due to the high vulnerability of private buildings, in particular, housing units. Results: Therefore, in recent years, several studies have been conducted on the seismic resilience of communities. However, significant improvements are still needed for the resilience assessment of the housing stock, both qualitatively and quantitatively. In this study, which is applied to the housing system, a proposal regarding a change in urban planning and emergency management tools based on the concept of resilience is reported. As a first application, a case study in Italy is considered. Conclusion: The proposal is focused on defining and quantifying the improvement of the resilience of the communities and this must be obtained by modifying the current Civil Protection plan. New tools are based on a new resilience community plan by encompassing urban planning tools, resilient mitigation strategies, and consequently, emergency management planning.

scholarly journals 307 A systems approach to understanding biosecurity decision-making

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 43-43
Author(s):  
Scott C Merrill ◽  
Christopher Koliba ◽  
Gabriela Bucini ◽  
Eric Clark ◽  
Luke Trinity ◽  
...  
Keyword(s):  
Decision Making ◽  
Negative Impact ◽  
Risk Mitigation ◽  
African Swine Fever Virus ◽  
The United States ◽  
Mitigation Strategies ◽  
Communication Strategy ◽  
Livestock Industry ◽  
Diarrhea Virus ◽  
Operational Level

Abstract Disease and its consequences result in social and economic impacts to the US animal livestock industry, ranging from losses in human capital to economic costs in excess of a billion dollars annually. Impacts would dramatically escalate if a devastating disease like Foot and Mouth Disease or African Swine Fever virus were to emerge in the United States. Investing in preventative biosecurity can reduce the likelihood of disease incursions and their negative impact on our livestock industry, yet uncertainty persists with regards to developing an effective biosecurity structure and culture. Here we show the implications of human behavior and decision making for biosecurity effectiveness, from the operational level to the owner/managerial level and finally to the systems level. For example, adjustments to risk messaging strategies could double worker compliance with biosecurity practices at the operational level. The improvement of our risk communication strategy may increase willingness to invest in biosecurity. Furthermore, the adaptation of policies could nudge behavior so that we observe a short disease outbreak followed by a quick eradication instead of a pandemic. Our research shows how the emergence of now-endemic diseases, such as Porcine Epidemic Diarrhea virus, cannot be adequately modeled without the use of a human behavioral component. Focusing solely on any one sector or level of the livestock system is not sufficient to predict emergent disease patterns and their social and economic impact on livestock industries. These results provide insight toward developing more effective risk mitigation strategies and ways to nudge behavior toward more disease resilient systems.

Avoiding Compressor Surge During Emergency Shutdown Hybrid Turbine Systems

2013 ◽  
Vol 135 (10) ◽  
Author(s):  
Paolo Pezzini ◽  
David Tucker ◽  
Alberto Traverso
Keyword(s):  
Fuel Cell ◽  
System Analysis ◽  
Risk Mitigation ◽  
Dynamic Effect ◽  
Transient Behavior ◽  
Open Loop ◽  
Department Of Energy ◽  
Mitigation Strategies ◽  
Emergency Shutdown ◽  
Compressor Surge

A new emergency shutdown procedure for a direct-fired fuel cell turbine hybrid power system was evaluated using a hardware-based simulation of an integrated gasifier/fuel cell/turbine hybrid cycle (IGFC), implemented through the Hybrid Performance (Hyper) project at the National Energy Technology Laboratory, U.S. Department of Energy (NETL). The Hyper facility is designed to explore dynamic operation of hybrid systems and quantitatively characterize such transient behavior. It is possible to model, test, and evaluate the effects of different parameters on the design and operation of a gasifier/fuel cell/gas turbine hybrid system and provide a means of quantifying risk mitigation strategies. An open-loop system analysis regarding the dynamic effect of bleed air, cold air bypass, and load bank is presented in order to evaluate the combination of these three main actuators during emergency shutdown. In the previous Hybrid control system architecture, catastrophic compressor failures were observed when the fuel and load bank were cut off during emergency shutdown strategy. Improvements were achieved using a nonlinear fuel valve ramp down when the load bank was not operating. Experiments in load bank operation show compressor surge and stall after emergency shutdown activation. The difficulties in finding an optimal compressor and cathode mass flow for mitigation of surge and stall using these actuators are illustrated.

Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence

2012 ◽  
Vol 10 (3) ◽  
pp. 200-205 ◽  
Author(s):  
Eric M. Thompson ◽  
Susan E. Wozniak ◽  
Colin M. Roberts ◽  
Amy Kao ◽  
Valerie C. Anderson ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Pediatric Patients ◽  
Medication Use ◽  
Partial Epilepsy ◽  
Seizure Duration ◽  
Antiepileptic Medication ◽  
Generalized Epilepsy

Object Vagus nerve stimulation (VNS) is approved by the FDA for the treatment of partial epilepsy in patients older than 12 years. Authors of the current study performed a large retrospective analysis and comparison of VNS outcomes in children with an age ≥ and < 12 years, including those with partial and generalized epilepsy. Methods A retrospective review of the records of pediatric patients (age < 18 years) who had undergone primary VNS system implantation between 2001 and 2010 by a single pediatric neurosurgeon was undertaken. Considered data included demographics, epilepsy type (partial vs generalized), seizure frequency, seizure duration, postictal period duration, and antiepileptic medication use. Results One hundred forty-six patients (49% female) were followed up for a mean of 41 months after VNS implantation. Thirty-two percent of patients had partial epilepsy and 68% had generalized epilepsy. After VNS system implantation, seizure frequency was reduced in 91% of patients, seizure duration in 50%, postictal period in 49%, and antiepileptic medication use in 75%. There was no significant difference in age, sex, or duration of follow-up according to epilepsy type. Neither was there any significant difference in seizure frequency reduction, seizure duration, postictal period, medication use, overall clinical improvement, or improvement in quality of life based on an age ≥ or < 12 years or epilepsy type. Conclusions Vagus nerve stimulation reduced both seizure frequency and antiepileptic medication use in the majority of pediatric patients regardless of sex, age cohort, or epilepsy type. Vagus nerve stimulation also reduced seizure duration and postictal period in approximately half of the pediatric patients. Contrary to expectation, children with partial epilepsy do not benefit from VNS at higher rates than those with generalized epilepsy.

A Low-Fidelity Stochastic Model of Viral Spread in Aircraft to Assess Risk Mitigation Strategies

2021 ◽  
Author(s):  
Leigh McCue
Keyword(s):  
Large Scale ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Traffic Network ◽  
Computationally Efficient ◽  
Passenger Compartment ◽  
Stochastic Effects ◽  
Viral Spread ◽  
Risk Mitigation Strategies ◽  
Baseline Health

Abstract The purpose of this work is to develop a computationally efficient model of viral spread that can be utilized to better understand influences of stochastic factors on a large-scale system - such as the air traffic network. A particle-based model of passengers and seats aboard a single-cabin 737-800 is developed for use as a demonstration of concept on tracking the propagation of a virus through the aircraft's passenger compartment over multiple flights. The model is sufficiently computationally efficient so as to be viable for Monte Carlo simulation to capture various stochastic effects, such as number of passengers, number of initially sick passengers, seating locations of passengers, and baseline health of each passenger. The computational tool is then exercised in demonstration for assessing risk mitigation of intervention strategies, such as passenger-driven cleaning of seating environments and elimination of middle seating.

Administrative risks challenging the adoption of smart contracts in construction projects

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Asli Pelin Gurgun ◽  
Kerim Koc
Keyword(s):  
Construction Projects ◽  
Risk Mitigation ◽  
Research Question ◽  
Group Discussion ◽  
Mitigation Strategies ◽  
Risk Category ◽  
Smart Contracts ◽  
Content Type ◽  
Smart Contract ◽  
Criteria Weights

PurposeAs a remedy to usually voluminous, complicated and not easily readable construction contracts, smart contracts can be considered as an effective and alternative solution. However, the construction industry is merely known as a frontrunner for fast adoption of recent technological advancements. Numerous administrative risks challenge construction companies to implement smart contracts. To highlight this issue, this study aims to assess the administrative risks of smart contract adoption in construction projects.Design/methodology/approachA literature survey is conducted to specify administrative risks of smart contracts followed by a pilot study to ensure that the framework is suitable to the research question. The criteria weights are calculated through the fuzzy analytical hierarchy process method, followed by a sensitivity analysis based on degree of fuzziness, which supports the robustness of the developed hierarchy and stability of the results. Then, a focus group discussion (FGD) is performed to discuss the mitigation strategies for the top-level risks in each risk category.FindingsThe final framework consists of 27 sub-criteria, which are categorized under five main criteria, namely, contractual, cultural, managerial, planning and relational. The findings show that (1) regulation change, (2) lack of a driving force, (3) works not accounted in planning, (4) shortcomings of current legal arrangements and (5) lack of dispute resolution mechanism are the top five risks challenging the adoption of smart contracts in construction projects. Risk mitigation strategies based on FGD show that improvements for the semi-automated smart contract drafting are considered more practicable compared to full automation.Originality/valueThe literature is limited in terms of the adoption of smart contracts, while the topic is receiving more attention recently. To support easy prevalence of smart contracts, this study attempts the most challenging aspects of smart contract adoption.

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