CME: A Look at Unsupervised Pediatric Drug Exposures

CME: A Look at Unsupervised Pediatric Drug Exposures

About a decade ago, several reports throughout the United States indicated that ED visits were on the rise for unsupervised pediatric medication exposures. “As a result of these studies, clinicians renewed their efforts to improve rates of these exposures,” explains Daniel S. Budnitz, MD, MPH. “Some of the steps were taken included improving safety packaging and increasing education to both healthcare providers and the general public about ways to avoid these exposures. By examining current trends in unsupervised pediatric medication exposures, it’s possible that this data could inform the development of targeted interventions to further reduce the risk of these events.”   Long-Term Trends For a study published in Pediatrics, Dr. Budnitz and colleagues examined data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project to assess trends in ED visits for unsupervised medication exposures among children younger than the age of 6 from 2004 to 2013. The investigators also identified the dosage form and prescription status of implicated medications from 2010 through 2013. The authors found that approximately 640,000 children were seen in the ED for ingesting drugs between 2004 and 2013. About 70.0% of these children were aged 1 or 2, and nearly 20.0% of this group was hospitalized. The number of pediatric ED visits for unsupervised medication exposures increased by an average of 5.7% annually during the early 2000s and peaked at about 76,000 visits in 2010. After 2010, however, this trend reversed, with the number of ED visits decreasing by an average of 6.7% per year to approximately 59,000 visits in 2013. “While the decreasing trend is encouraging, this figure is still...
A Look at Unsupervised Pediatric Drug Exposures

A Look at Unsupervised Pediatric Drug Exposures

About a decade ago, several reports throughout the United States indicated that ED visits were on the rise for unsupervised pediatric medication exposures. “As a result of these studies, clinicians renewed their efforts to improve rates of these exposures,” explains Daniel S. Budnitz, MD, MPH. “Some of the steps were taken included improving safety packaging and increasing education to both healthcare providers and the general public about ways to avoid these exposures. By examining current trends in unsupervised pediatric medication exposures, it’s possible that this data could inform the development of targeted interventions to further reduce the risk of these events.”   Long-Term Trends For a study published in Pediatrics, Dr. Budnitz and colleagues examined data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project to assess trends in ED visits for unsupervised medication exposures among children younger than the age of 6 from 2004 to 2013. The investigators also identified the dosage form and prescription status of implicated medications from 2010 through 2013. The authors found that approximately 640,000 children were seen in the ED for ingesting drugs between 2004 and 2013. About 70.0% of these children were aged 1 or 2, and nearly 20.0% of this group was hospitalized. The number of pediatric ED visits for unsupervised medication exposures increased by an average of 5.7% annually during the early 2000s and peaked at about 76,000 visits in 2010. After 2010, however, this trend reversed, with the number of ED visits decreasing by an average of 6.7% per year to approximately 59,000 visits in 2013. “While the decreasing trend is encouraging, this figure is still...
Patient Safety: Surveying Orthopedic Surgeons

Patient Safety: Surveying Orthopedic Surgeons

Throughout the United States, hospitals and health systems are not high-reliability organizations, but are attempting to become high-reliability organizations. Efforts are being made to build on quality and safety advances with a variety of interventions. However, little is known if these actions are helping reduce medical errors and improve outcomes. Patients expect these organizations to adopt a culture of safety, but physicians expect to err, making it critical to create continued awareness of processes that are and are not working. A culture of safety requires being reluctant to accept simple or incomplete explanations for problems, deferring to experts with the most knowledge about specific tasks regardless of hierarchy, and adapting quickly and effectively when making changes. “We know from the aviation and manufacturing industries that work culture can influence the safety of people using these services,” says James H. Herndon, MD, MBA. “Gaining a better understanding about the attitudes of physicians on safety might help improve the hospital safety culture.”   Assessing Opinions For a study published in the Journal of Bone and Joint Surgery, Dr. Herndon and colleagues assessed opinions of nearly 400 orthopedic surgeons on their current patient safety culture and about their enthusiasm for different ways to improve safety. The investigators also analyzed their views on the perceived preventability of specific adverse events and factors that orthopedic surgeons saw as being important for improving safety. Participants were given a modified version of the Patient Safety Climate in Healthcare Organizations questionnaire, which measures safety as perceived by hospital personnel. According to the results, the rate of problematic responses—those implying a lack of safety climate—in the modified questionnaire...
Reducing Pediatric Drug Errors in Rural EDs

Reducing Pediatric Drug Errors in Rural EDs

Previous research has shown that patients receiving treatment in EDs are at particularly high risk for experiencing medication errors because of the acute nature of presenting illnesses, the chaotic environment, and the lack of oversight to verify medication orders and administration, among other reasons. For children, the risk of medication errors is heightened because weight-based drug dosing practices are common in this patient population. In addition, many healthcare providers have limited experience with pediatric prescribing and pharmacotherapy. Several studies have suggested that physician prescribing is the most common source of medication errors among children and in EDs. Physicians practicing in rural areas face distinct disadvantages when caring for seriously ill or injured pediatric patients. “Several factors can contribute to the increased risk of medication errors in children receiving care in rural EDs,” explains James P. Marcin, MD, MPH. “These may include issues relating to physician experience and specialized training as well as infrastructural factors.” The Role of Telemedicine To address shortcomings, telemedicine is increasingly being used as an alternative to telephone consultations for providing pediatric specialty consultations to children presenting to rural and underserved EDs throughout the United States. “Telemedicine has the potential to prevent medication errors that result from the lack of access to experienced staff and pediatric specialty expertise,” says Dr. Marcin. “Research has shown that having specialists treat children can lower risks of medication errors.” He notes, however, that although telemedicine has been proposed as a potential solution, few data support its clinical effectiveness and its effect on medication errors. A Closer Look In a study published in Pediatrics, Dr. Marcin and colleagues evaluated whether pediatric...
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