Differences in adverse drug events and medication errors among pediatric inpatients aged <3 and ≥3 years: The JADE study

2021 ◽  
pp. 251604352110467
Author(s):  
Jiro Takeuchi ◽  
Mio Sakuma ◽  
Yoshinori Ohta ◽  
Hiroyuki Ida ◽  
Takeshi Morimoto
Keyword(s):  
Hospital Stay ◽  
Medication Errors ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Adverse Drug Events ◽  
Medication Use ◽  
Skill Levels ◽  
Linguistic Skills ◽  
Events Study

Background Adverse drug events (ADEs) are defined as any injuries due to medication use. We hypothesized that the incidences of ADEs and medication errors (MEs) could be associated with linguistic skills of pediatric patients. Methods We analyzed data from the Japan Adverse Drug Events study on pediatric inpatients. This study included inpatients aged one months and older and less than seven years old. We compared the primary outcome of ADEs and MEs between patients aged under three years and three years and older as children typically do not acquire sufficient linguistic skills until around three years of age. Results This study included 639 patients; 412 (64%) patients aged under three years and 227 (36%) patients aged three years and older. We identified 241 ADEs in 639 patients; 152 ADEs among patients aged under three years (37 ADEs per 100 patients) and 89 ADEs among those aged three years and older (39 ADEs per 100 patients). ADEs among patients aged under three years were less likely to be found (49 ADEs) during their hospital stay than those aged three years and older (20 ADEs) ( P = 0.02). Among 172 MEs identified in 639 patients, 25 MEs (15%) resulted in ADEs; 23 (92%) occurred to those aged under three years and two (8%) occurred to those aged three years and older ( P = 0.0008). Conclusion ADEs were less likely to be found and MEs resulted in ADEs more frequently in patients under three years old, and these differences could be explained by differences in their linguistic skill levels.

scholarly journals The Burden of Preventable Adverse Drug Events on Hospital Stay and Healthcare Costs in Japanese Pediatric Inpatients: The JADE Study

2021 ◽  
Vol 15 ◽  
pp. 117955652199583
Author(s):  
Hitoshi Iwasaki ◽  
Mio Sakuma ◽  
Hiroyuki Ida ◽  
Takeshi Morimoto
Keyword(s):  
Hospital Stay ◽  
Medication Errors ◽  
Healthcare Costs ◽  
Pediatric Patients ◽  
Adverse Drug Events ◽  
Length Of Hospital Stay ◽  
Sensitivity Analyses ◽  
National Burden ◽  
The Individual ◽  
Preventable Ades

Background: Adverse drug events (ADEs) are a burden to the healthcare system. Preventable ADEs, which was ADEs due to medication errors, could be reduced if medication errors can be prevent or ameliorate. Objective: We investigated the burden of preventable ADEs on the length of hospital stay (LOS) and costs, and estimated the national burden of preventable ADEs in pediatric inpatients in Japan. Methods: We analyzed data from the Japan Adverse Drug Events (JADE) study on pediatric patients and estimated the incidence of preventable ADEs and associated extended LOS. Costs attributable to extended LOS by preventable ADEs were calculated using a national statistics database and we calculated the effect of preventable ADEs on national cost excess. Results: We included 907 patients with 7377 patient-days. Among them, 31 patients (3.4%) experienced preventable ADEs during hospitalization. Preventable ADEs significantly increased the LOS by 14.1 days, adjusting for gender, age, ward, resident physician, surgery during hospitalization, cancer, and severe malformation at birth. The individual cost due to the extended LOS of 14.1 days was estimated as USD 8258. We calculated the annual extra expense for preventable ADEs in Japan as USD 329 676 760. Sensitivity analyses, considering the incidence of preventable ADEs and the length of hospital stay, showed that the expected range of annual extra expense for preventable ADEs in Japan is between USD 141 468 968 and 588 450 708. Conclusion: Preventable ADEs caused longer hospitalization and considerable extra healthcare costs in pediatric inpatients. Our results would encourage further efforts to prevent and ameliorate preventable ADEs.

Improving Medication Safety Through the Use of Metrics

2013 ◽  
Vol 27 (1) ◽  
pp. 61-64
Author(s):  
Robert D. Beckett ◽  
Marina Yazdi ◽  
Laura J. Hanson ◽  
Ross W. Thompson
Keyword(s):  
Medication Errors ◽  
Medication Safety ◽  
Adverse Drug Events ◽  
Safety Information ◽  
Medication Use ◽  
Cross Sectional Study ◽  
Survey Instrument ◽  
Sectional Study ◽  
Cross Sectional ◽  
Safety Metrics

Purpose: Describe medication safety metrics used at University HealthSystem Consortium (UHC) institutions and recommend a meaningful way to report and communicate medication safety information across an organization. Methods: A cross-sectional study was conducted using an electronically distributed, open-ended survey instrument. Results: Twenty percent of the UHC institutions responded to our survey. Seventy-seven percent of those institutions responding to our survey reported their organization has defined metrics to measure medication safety; an additional 21% of the institutions were still in the process of defining metrics. Of metrics that were reported, 33% were true medication safety metrics. Results are distributed to a wide variety of institutional venues. Conclusion: Institutions should take several actions related to medication safety including defining local metrics; building metrics addressing preventable adverse drug events, medication errors, and technology; and reporting results to a variety of venues in order to design specific interventions to improve local medication use.

scholarly journals Adverse Drug Events due to Central Nervous System Depressant Drugs in Pediatric Patients With or Without Surgery

2020 ◽  
Vol 25 (4) ◽  
pp. 295-302
Author(s):  
Marumi Yamamoto ◽  
Yoshinori Ohta ◽  
Mio Sakuma ◽  
Chisa Matsumoto ◽  
Takeshi Morimoto
Keyword(s):  
Pediatric Patients ◽  
Adverse Drug Events ◽  
Cns Depressant ◽  
Potential Ades ◽  
Surgery Group ◽  
Central Nervous System Depressant ◽  
Life Threatening ◽  
Group A ◽  
Incident Reports ◽  
Events Study

OBJECTIVES To identify differences in the incidence and severity of adverse drug events (ADEs) due to CNS depressant drugs among pediatric patients with and without surgery. METHODS The Japan Adverse Drug Events Study was a cohort study enrolling pediatric inpatients. Potential ADEs were identified by onsite review of medical charts, incident reports, and prescription queries. Two independent physicians classified ADEs and severity. We compared the incidence and characteristics of ADEs between pediatric patients with surgery (surgery group) and without surgery (non-surgery group). We evaluated severity of ADEs due to CNS depressant drugs among both groups. RESULTS We enrolled 944 patients, 234 in surgery group and 710 in non-surgery group. A total of 480 ADEs due to any drugs occurred in 225 patients. Among 81 ADEs due to CNS depressant drugs, 42 ADEs were in surgery group, whereas 39 were in non-surgery group. The risk of fatal or life-threatening ADEs due to CNS depressant drugs was significantly higher than other drugs (12% vs. 2%, p &lt; 0.001). In the surgery group, anesthetics led to 2 fatal or life-threatening, 8 serious, and 30 significant ADEs, whereas in the non-surgery group anesthetics led to 2 fatal or life-threatening, 5 serious, and 4 significant ADEs. Anesthetics were higher risk in the non-surgery group (p = 0.049). CONCLUSIONS The risks of fatal and life-threatening ADEs were significantly higher with CNS depressant drugs than other drugs. Pediatric patients without surgery have higher risks of fatal or life-threatening ADEs due to anesthetics than those with surgery.

Prevention of Medication Errors in Hospitalized Patients: The Japan Adverse Drug Events Study

Drug Safety ◽  
2016 ◽  
Vol 39 (11) ◽  
pp. 1129-1137 ◽  
Author(s):  
Chihiro Noguchi ◽  
Mio Sakuma ◽  
Yoshinori Ohta ◽  
David W. Bates ◽  
Takeshi Morimoto
Keyword(s):  
Medication Errors ◽  
Adverse Drug Events ◽  
Hospitalized Patients ◽  
Events Study ◽  
Prevention Of Medication Errors

scholarly journals Medication Errors in Adolescents Using Asthma Controller Medications

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098134
Author(s):  
Henry Clark ◽  
Delesha Carpenter ◽  
Kathleen Walsh ◽  
Scott A. Davis ◽  
Nacire Garcia ◽  
...  
Keyword(s):  
Medical Record ◽  
Medication Errors ◽  
Medication Use ◽  
Persistent Asthma ◽  
Cross Sectional Study ◽  
Asthma Medication ◽  
Sectional Study ◽  
Cross Sectional ◽  
Controller Medication ◽  
Controller Medications

The purpose of this study was to describe the number and types of errors that adolescents and caregivers report making when using asthma controller medications. A total of 319 adolescents ages 11 to 17 with persistent asthma and their caregivers participated in this cross-sectional study. Adolescent and caregiver reports of asthma medication use were compared to the prescribed directions in the medical record. An error was defined as discrepancies between reported use and the prescribed directions. About 38% of adolescents reported 1 error in using asthma controller medications, 16% reported 2 errors, and 5% reported 3 or more errors. About 42% of caregivers reported 1 error in adolescents using asthma controller medications, 14% reported 2 errors, while 6% reported 3 or more errors. The type of error most frequently reported by both was not taking the medication at all. Providers should ask open-ended questions of adolescents with asthma during visits so they can detect and educate families on how to overcome errors in taking controller medication use.

scholarly journals Using ActionADE to create information continuity to reduce re-exposures to harmful medications: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jeffrey P. Hau ◽  
Penelope M. A. Brasher ◽  
Amber Cragg ◽  
Serena Small ◽  
Maeve Wickham ◽  
...  
Keyword(s):  
Health Information ◽  
Adverse Drug Event ◽  
Primary Outcome ◽  
Adverse Drug Events ◽  
Primary Objective ◽  
Drug Event ◽  
Controlled Trials ◽  
Drug Reactions ◽  
Main Trial ◽  
Randomized Controlled

Abstract Background Repeat exposures to culprit medications are a common cause of preventable adverse drug events. Health information technologies have the potential to reduce repeat adverse drug events by improving information continuity. However, they rarely interoperate to ensure providers can view adverse drug events documented in other systems. We designed ActionADE to enable rapid documentation of adverse drug events and communication of standardized information across health sectors by integrating with legacy systems. We will leverage ActionADE’s implementation to conduct two parallel, randomized trials: patients with adverse drug reactions in the main trial and those diagnosed with non-adherence in a secondary trial. Primary objective of the main trial is to evaluate the effects of providing information continuity about adverse drug reactions on culprit medication re-dispensations over 12 months. Primary objective of the secondary trial is to evaluate the effect of providing information continuity on adherence over 12 months. Methods We will conduct two parallel group, triple-blind randomized controlled trials in participating hospitals in British Columbia, Canada. We will enroll adults presenting to hospital with an adverse drug event to prescribed outpatient medication. Clinicians will document the adverse drug event in ActionADE. The software will use an algorithm to determine patient eligibility and allocate eligible patients to experimental or control. In the experimental arm, ActionADE will transmit information to PharmaNet, where adverse drug event information will be displayed in community pharmacies when re-dispensations are attempted. In the control arm, ActionADE will retain information in the local record. We will enroll 3600 adults with an adverse drug reaction into the main trial. The main trial’s primary outcome is re-dispensation of a culprit or same-class medication within 12 months; the secondary trial’s primary outcome will be adherence to culprit medication. Secondary outcomes include health services utilization and mortality. Discussion These studies have the potential to guide policy decisions and investments needed to drive health information technology integrations to prevent repeat adverse drug events. We present an example of how a health information technology implementation can be leveraged to conduct pragmatic randomized controlled trials. Trial registration ClinicalTrials.gov NCT04568668, NCT04574648. Registered on 1 October 2020.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals Preventable adverse drug events causing hospitalisation: identifying root causes and developing a surveillance and learning system at an urban community hospital, a cross-sectional observational study

2021 ◽  
Vol 10 (1) ◽  
pp. e001161
Author(s):  
Jane de Lemos ◽  
Peter Loewen ◽  
Cheryl Nagle ◽  
Robert McKenzie ◽  
Yong Dong You ◽  
...  
Keyword(s):  
Observational Study ◽  
Adverse Drug Events ◽  
Healthcare Providers ◽  
Medication Use ◽  
Learning System ◽  
Chronic Obstructive ◽  
Action Plans ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Medication Changes

ObjectivesTo identify root causes of preventable adverse drug events (pADEs) contributing to hospital admission; to develop key messages which identify actions patients/families and healthcare providers can take to prevent common pADEs found; to develop a surveillance learning system for the community.MethodsCross-sectional observational study; 120 patients and families, 61 associated healthcare providers were interviewed then root cause analysis was performed to develop key learning messages and an electronic reporting tool was designed. Most common pADE-related medical conditions and their root causes and most common pADE root causes of entire cohort are reported.ResultsMost common pADE-related medical conditions: chronic obstructive pulmonary disease/asthma (13.3%), bleeding (12.5%), hypotension (12%), heart failure (10%), acute kidney injury (5%) and pneumonia (5%). Most common root causes were: providers not confirming that the patient/family understands information given (29.2%), can identify how a medication helps them/have their concerns addressed (16.7%), can identify if a medication is working (14.1%) or causing a side effect (23.3%); can enact medication changes (7.5%); absence of a sick day management plan (12.5%), and other action plans to help patients respond to changes in their clinical status (10.8%); providers not assessing medication use and monitoring competency (19.2%). Ten key learning messages were developed and a pADE surveillance learning system was implemented.ConclusionsTo prevent pADEs, providers need to confirm that patients/families understand information given, how a medication helps them, how to recognise and respond to side effects, how to enact medication changes and follow action plans; providers should assess patient’s/families’ medication use and monitoring competency.

scholarly journals Interventions to optimize medication use in nursing homes: a narrative review

2021 ◽  
Author(s):  
Anne Spinewine ◽  
Perrine Evrard ◽  
Carmel Hughes
Keyword(s):  
Nursing Homes ◽  
Large Scale ◽  
Adverse Drug Events ◽  
Experimental Studies ◽  
Medication Use ◽  
Nursing Home Residents ◽  
Qualitative Studies ◽  
Patient Centered ◽  
Barriers And Enablers ◽  
Specific Medication

Abstract Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

Evaluation of an Electronic Dosing Calculator to Reduce Pediatric Medication Errors

2019 ◽  
Vol 58 (4) ◽  
pp. 413-416
Author(s):  
Brian Murray ◽  
Matthew J. Streitz ◽  
Michael Hilliard ◽  
Joseph K. Maddry
Keyword(s):  
Patient Safety ◽  
Medication Errors ◽  
Prospective Cohort ◽  
Pediatric Patients ◽  
Cohort Analysis ◽  
Morbidity And Mortality ◽  
Patient Visit ◽  
Significant Morbidity ◽  
Potential Source ◽  
Medication Dosage

Introduction. Adverse medication events are a potential source of significant morbidity and mortality in pediatric patients, where dosages frequently rely on weight-based formulas. The most frequent occurrence of medication errors occurs during the ordering phase. Methods. Through a prospective cohort analysis, we followed medication errors through patient safety reports (PSRs) to determine if the use of a medication dosage calculator would reduce the number of PSRs per patient visits. Results. The number of PSRs for medication errors per patient visit occurring due to errors in ordering decreased from 10/28 417 to 1/17 940, a decrease by a factor of 6.31, with a χ2 value of 4.063, P = .0463. Conclusion. We conclude that the use of an electronic dosing calculator is able to reduce the number of medication errors, thereby reducing the potential for serious pediatric adverse medication events.

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