Allergy Safety Events in Health Care: Development and Application of a Classification Schema Based on Retrospective Review

Evaluating Family Safety Reporting Through an Operational and Research Taxonomy

OBJECTIVE

Integrating family-reported safety data into hospitals' operational safety reporting systems could enrich them, but requires understanding how reports would be classified. We sought to evaluate how family safety reports would be classified in an operational system and compare classifications with a newer research taxonomy.

DESIGN/METHODS

We prospectively collected safety reports from English and Spanish-speaking families of children hospitalized in a pediatric quaternary hospital's complex care service. Three physicians scored reports using research (modified Bates and colleagues and NCC-MERP) and operational taxonomies. In total, 10% of reports were reviewed independently to determine interrater reliability [kappa (κ)].

RESULTS

In total, 132 families provided 289 reports. Research κ (% agreement) was 0.40 (52.0%) for safety classification and 0.58 (68.0%) for NCC-MERP category. Operational κ was 0.46 (62.5%) for severity. κ for preventability, a shared category across operational and research taxonomies, was 0.53 (76.9%). Using operational taxonomy, reports were commonly classified as medications and fluids (29.8%, n=86), severity level 1 (no harm; 34.6%, n=100), with 34.9% (n=101) deemed unclassifiable. Using research taxonomy, reports were most commonly medicine/IV fluids (36.3%, n=105), nonharmful errors (38.4%, n=111), non-safety-related quality (30.8%, n=89), and NCC-MERP C (29.8%, n=86). 63% (n=182) were possibly preventable/preventable.

CONCLUSIONS

Operational and research taxonomies classify family-reported safety events similarly, though many are nonclassifiable in the operational taxonomy. Research taxonomy characterized family-reported concerns, including quality and environmental hazards, highlighting important aspects that operational systems do not capture. Hospitals and researchers should include family-reported data, and operational systems could add research categories to better capture safety and quality information from families.

Need for User-Friendly Audit Tools: Investigating Dietitians' Use and Requirements of Clinical Documentation Audit Tools

INTRODUCTION

High-quality clinical documentation is critical for ensuring patient safety, enhancing quality of care and outcomes management. Despite the recognised importance of standardised clinical documentation, particularly through the Nutrition Care Process (NCP) and its associated terminology, studies indicate flaws in current practices that may have negative impacts on patient outcomes and interprofessional communication. Regular auditing of clinical documentation could help in improving clinical documentation quality. Despite the availability of validation studies of clinical documentation audit tools, information on their use and dietitians' requirements is lacking. This study aimed to investigate the dietitians' use of clinical documentation audit tools internationally and to learn about their requirements for these tools.

METHODS

A quantitative cross-sectional online survey was conducted in October 2021 using a newly developed and pretested 26-item questionnaire among dietitians identified through convenience sampling. The survey, developed through a multi-step approach including expert review and pretesting, collected data on clinical documentation audit tool use, purpose of auditing, preferred tool formats, and perceived enablers and barriers. Descriptive statistics and inferential analyses were applied to compare current practices and desired future applications of current auditors and non-auditors.

RESULTS

A total of 154 respondents from 16 countries completed the survey, with more than half working in patient-related fields. Fifty-three percent indicated that clinical documentation audits were conducted in their workplaces Audit purpose was primarily improving clinical documentation quality, reinforcing NCP understanding, and enhancing clarity, with significant differences observed between current and desired uses regarding result comparability and quality reporting (p < 0.001). Key enablers included management support, education/training, time, and helpful manuals, while barriers included lack of knowledge, time constraints, and insufficient training. Auditors used the tools mainly in paper format (33%) or as a text processing/spreadsheet file (26%), with 51% preferring a web application in the future. Additional requirements included further manual development, benchmarking capabilities, and cross-cultural adaptations.

CONCLUSION

The process of clinical documentation auditing is not well established in the nutrition and dietetics community but has the potential to enhance clinical documentation quality. Key requirements include best practices for clinical documentation auditing processes, educational resources and user-friendly, web-based tools. Future research should validate clinical documentation audit tools across different settings and explore barriers to clinical documentation auditing as well as evaluating the use of artificial intelligence for clinical documentation auditing, ensuring improved clinical documentation quality translates to better patient care.

A scoping review of rule-based clinical decision support malfunctions

OBJECTIVE

Conduct a scoping review of research studies that describe rule-based clinical decision support (CDS) malfunctions.

MATERIALS AND METHODS

In April 2022, we searched three bibliographic databases (MEDLINE, CINAHL, and Embase) for literature referencing CDS malfunctions. We coded the identified malfunctions according to an existing CDS malfunction taxonomy and added new categories for factors not already captured. We also extracted and summarized information related to the CDS system, such as architecture, data source, and data format.

RESULTS

Twenty-eight articles met inclusion criteria, capturing 130 malfunctions. Architectures used included stand-alone systems (eg, web-based calculator), integrated systems (eg, best practices alerts), and service-oriented architectures (eg, distributed systems like SMART or CDS Hooks). No standards-based CDS malfunctions were identified. The "Cause" category of the original taxonomy includes three new types (organizational policy, hardware error, and data source) and two existing causes were expanded to include additional layers. Only 29 malfunctions (22%) described the potential impact of the malfunction on patient care.

DISCUSSION

While a substantial amount of research on CDS exists, our review indicates there is a limited focus on CDS malfunctions, with even less attention on malfunctions associated with modern delivery architectures such as SMART and CDS Hooks.

CONCLUSION

CDS malfunctions can and do occur across several different care delivery architectures. To account for advances in health information technology, existing taxonomies of CDS malfunctions must be continually updated. This will be especially important for service-oriented architectures, which connect several disparate systems, and are increasing in use.

Taxonomy development methods regarding patient safety in health sciences - A systematic review

BACKGROUND

Taxonomies are needed for automated analysis of clinical data in healthcare. Few reviews of the taxonomy development methods used in health sciences are found. This systematic review aimed to describe the scope of the available taxonomies relative to patient safety, the methods used for taxonomy development, and the strengths and limitations of the methods. The purpose of this systematic review is to guide future taxonomy development projects.

METHODS

The CINAHL, PubMed, Scopus, and Web of Science databases were searched for studies from January 2012 to April 25, 2023. Two authors selected the studies using inclusion and exclusion criteria and critical appraisal checklists. The data were analysed inductively, and the results were reported narratively.

RESULTS

The studies (n = 13) across healthcare concerned mainly taxonomies of adverse events and medication safety but little for specialised fields and information technology. Critical appraisal indicated inadequate reporting of the used taxonomy development methods. Ten phases of taxonomy development were identified: (1) defining purpose and (2) the theory base for development, (3) relevant data sources' identification, (4) main terms' identification and definitions, (5) items' coding and pooling, (6) reliability and validity evaluation of coding and/or codes, (7) development of a hierarchical structure, (8) testing the structure, (9) piloting the taxonomy and (10) reporting application and validation of the final taxonomy. Seventeen statistical tests and seven software systems were utilised, but automated data extraction methods were used rarely. Multimethod and multi-stakeholder approach, code- and hierarchy testing and piloting were strengths and time consumption and small samples in testing limitations.

CONCLUSION

New taxonomies are needed on diverse specialities and information technology related to patient safety. Structured method is needed for taxonomy development, reporting and appraisal to strengthen taxonomies' quality. A new guide was proposed for taxonomy development, for which testing is required. Prospero registration number CRD42023411022.

Latex Allergy - From Discovery to Component-resolved Diagnosis

Latex allergy is a hypersensitivity response to natural rubber latex (NRL) proteins or rubber chemicals used in the manufacture of latex products. An accurate diagnosis is the first step in the effective management of individuals with latex allergy, especially in high-risk groups, such as healthcare workers and those affected by spina bifida. Diagnosis is based on the clinical history and an accurate allergological evaluation. In the case of type I IgE-mediated hypersensitivity reactions, which can manifest urticaria, angioedema, rhinoconjunctivitis, asthma and anaphylaxis after latex exposure, skin prick tests or latex-specific IgE (sIgE) antibody detection using serological assays can be performed to confirm sensitization. Instead, in the case of contact dermatitis, a patch test can be applied to confirm the presence of a type IV T cell-mediated hypersensitivity reaction to rubber accelerators or additives. Basophils activation tests or challenge tests may be performed if there's an incongruity between the clinical history and the results of in vivo and in vitro tests. The aim of this review is to analyze the current state of the art of diagnostic techniques for latex allergy and algorithms employed in clinical practice and possible future developments in this field.

Use of the Electronic Health Record for Monitoring Adverse Drug Reactions

PURPOSE OF REVIEW

Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality. The electronic health record (EHR) provides an opportunity to monitor ADRs, mainly through the utilization of drug allergy data and pharmacogenomics. This review article explores the current use of the EHR for ADR monitoring and highlights areas that require improvement.

RECENT FINDINGS

Recent research has identified several issues with using EHR for ADR monitoring. These include the lack of standardization between EHR systems, specificity in data entry options, incomplete and inaccurate documentation, and alert fatigue. These issues can limit the effectiveness of ADR monitoring and compromise patient safety. The EHR has great potential for monitoring ADR but needs significant updates to improve patient safety and optimize care. Future research should concentrate on developing standardized documentation and clinical decision support systems within EHRs. Healthcare professionals should also be educated on the significance of accurate and complete ADR monitoring.