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Mueller EL, Cochrane AR, Carroll AE. Perceptions of chemotherapy calendar creation among US pediatric oncologists. Pediatr Blood Cancer 2023; 70:e30688. [PMID: 37737717 PMCID: PMC10615882 DOI: 10.1002/pbc.30688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND An effective chemotherapy calendar system between the clinician and the patient/caregiver can improve patient-centered outcomes. There is lack of research on how chemotherapy calendars are created and what aspects are important to pediatric oncology physicians. PROCEDURE In an online survey of pediatric oncology physicians, we evaluated institutional practices, perceptions of chemotherapy calendar creation, and desires for future tools. A total of 220 survey participants provided data (10.4% participant response rate) from 123 institutions (53.5% represented institutions). RESULTS Participants indicated that 72% always or most of the time their institution provides a chemotherapy calendar, most commonly at the start of a new cycle (90%) or with a dosing change (68%). Factors such as the health literacy of the family, prior nonadherence, type of cancer, and desire of the family affected the creation decision. Advanced practice providers (45%) or nurse coordinator/navigators (43%) were most likely to create the chemotherapy calendar. No significant difference was found between the likelihood of creating a chemotherapy calendar and institutional size (p = .09) or physician years in practice (p = .26). Approximately 95% of participants indicated chemotherapy calendar creation software that improved ease and efficiency would be moderately to extremely useful. CONCLUSION Future efforts should focus on co-design of an efficient and effective chemotherapy calendar by engaging with nursing and advanced practice providers along with caregivers of children with cancer.
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Affiliation(s)
- Emily L Mueller
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202
| | - Anneli R Cochrane
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202
| | - Aaron E Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
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2
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Chachlioutaki K, Gioumouxouzis C, Karavasili C, Fatouros DG. Small patients, big challenges: navigating pediatric drug manipulations to prevent medication errors - a comprehensive review. Expert Opin Drug Deliv 2023; 20:1489-1509. [PMID: 37857515 DOI: 10.1080/17425247.2023.2273838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Medication errors during drug manipulations in pediatric care pose significant challenges to patient safety and optimal medication management. Epidemiological studies have revealed a high prevalenceof medication errors throughout the medication process. Due to the lack of age-appropriate dosage forms, medication manipulation is common in pediatric drug administration. The consequences of these manipulations on drug efficacy and safety could be devastating, highlighting the need for evidence-based guidelines and standardized compounding practices. AREAS COVERED This review focuses on examining medication errors in pediatric care and delving into the manipulation of medicinal products. EXPERT OPINION The observed prevalence of medication errors and manipulations underscores the importance of addressing these issues to enhance patient safety and improve medication outcomes in pediatric care. Overall, the development of age-appropriate formulations and the dissemination of comprehensive clinical guidelines are essential steps toward improving medication safety and minimizing manipulations in pediatric healthcare settings.
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Affiliation(s)
- Konstantina Chachlioutaki
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
| | - Christos Gioumouxouzis
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Karavasili
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Fatouros
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
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3
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Kirkendall ES, Brady PW, Corathers SD, Ruddy RM, Fox C, Nelson H, Wetterneck TB, Rodgers I, Walsh KE. Safer Type 1 Diabetes Care at Home: SEIPS-based Process Mapping with Parents and Clinicians. Pediatr Qual Saf 2023; 8:e649. [PMID: 38571735 PMCID: PMC10990404 DOI: 10.1097/pq9.0000000000000649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/02/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction The limited data indicate that pediatric medical errors in the outpatient setting, including at home, are common. This study is the first step of our Ambulatory Pediatric Patient Safety Learning Lab to address medication errors and treatment delays among children with T1D in the outpatient setting. We aimed to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with T1D. Methods A transdisciplinary team of parents, safety researchers, and clinicians used Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping of data we collected through in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Results Eight (57%) of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two were due to repeated failures to administer insulin at home properly. In SEIPS-based process maps, high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care, especially during evolving illness. Conclusion Using SEIPS-based process maps informed by multimodal methods to identify medication errors and treatment delays, we found errors were common. Better support for managing acute illness at home and improved communication between the clinic and home are potentially high-yield interventions.
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Affiliation(s)
- Eric S. Kirkendall
- From the Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, N.C
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, N.C
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, N.C
| | - Patrick W. Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah D. Corathers
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Richard M. Ruddy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Catherine Fox
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Hailee Nelson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tosha B. Wetterneck
- Department of Medicine, Division of General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Isabelle Rodgers
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
| | - Kathleen E. Walsh
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
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4
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Wong CI, Vannatta K, Gilleland Marchak J, Quade EV, Rodgers IM, Reid CM, Dandoy CE, Billett AL, Miller TP, Vaughn S, Daraiseh NM, Liu S, Carle AC, Walsh KE. Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: A multisite longitudinal assessment. Cancer 2023; 129:1064-1074. [PMID: 36704995 DOI: 10.1002/cncr.34651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is little longitudinal information about the type and frequency of harm resulting from medication errors among outpatient children with cancer. We aimed to characterize rates and types of medication errors and harm to outpatient children with leukemia and lymphoma over 7 months of treatment. METHODS We recruited children taking medications at home for leukemia or lymphoma from three pediatric cancer centers. Errors were identified by chart review, in-home medication review, observation of administration, and interviews. Physician reviewers confirmed error (Fleiss' κ = 0.95), harm (Fleiss' κ = 0.82), and suggested interventions. Generalized linear mixed models with random effects were used to account for clustering by site. RESULTS Among 131 children taking 1669 medications with 367 home visits, 408 errors were identified, including 242 with potential for harm and 39 with harm (1.0 harm per 1000 patient-days [95% CI, 0.1-9.8]). Ten percent of children were injured by errors and 42% had errors with potential for harm. Twenty-six percent of caregivers reported that miscommunication led to missed doses or overdoses at home. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). CONCLUSIONS In this longitudinal study, 10% children with leukemia or lymphoma experienced adverse drug events because of outpatient medication errors. Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering. PLAIN LANGUAGE SUMMARY In this longitudinal study, medication errors in the clinic, pharmacy, or at home among children with leukemia or lymphoma over a 7-month period were common, and 10% suffered harm because of errors. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering.
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Affiliation(s)
- Chris I Wong
- Pediatric Hematology-Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
- Medical Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Emeric V Quade
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Isabelle M Rodgers
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christine M Reid
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amy L Billett
- Quality and Safety Program, Nemours Children's Health, Delaware Valley, Wilmington, Delaware, USA
| | - Tamara P Miller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Shelley Vaughn
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nancy M Daraiseh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shanshan Liu
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Institutional Centers for Clinical Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam C Carle
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- College of Medicine University of Cincinnati, Cincinnati, Ohio, USA
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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5
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Akkawi El Edelbi R, Eksborg S, Kreicbergs U, Lövgren M, Wallén K, Ekman J, Lindemalm S. Parents' experiences of handling oral anticancer drugs at home: 'It all falls on me …'. J Eval Clin Pract 2023; 29:94-100. [PMID: 35927976 PMCID: PMC10086976 DOI: 10.1111/jep.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 01/18/2023]
Abstract
AIM The aim of this study was to describe the experiences of parents handling oral anticancer drugs in a home setting. METHODS Parents of children with cancer were recruited from a paediatric oncology ward in Sweden to participate in an interview. The interviews were transcribed verbatim and subjected to qualitative content analysis. RESULTS We found the following categories and subcategories: parents' views on the provided information-lack of, too little or contradictory information, and parents' preferences for information delivery; safety over time; correct drug dose; and drug administration. As time passed, most parents adapted to their child's illness, felt safer and found it easier to take in and process any given information. Parents preferred information in different formats (written, movie clips and orally) and in their mother tongue. Many parents were aware of the importance of giving an accurate dose to their child and described the process of drug administration as overwhelming. CONCLUSION Parents need to be provided with accurate, timely, nonconflicting and repeated information-in different forms and in their mother tongue-on how to handle oral anticancer drugs at home.
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Affiliation(s)
- Ranaa Akkawi El Edelbi
- Department of Women's and Children's Health, Childhood Cancer Research UnitKarolinska InstitutetStockholmSweden
- Division of Pediatrics, Karolinska University HospitalAstrid Lindgren Children's HospitalStockholmSweden
| | - Staffan Eksborg
- Department of Women's and Children's Health, Childhood Cancer Research UnitKarolinska InstitutetStockholmSweden
- Division of Pediatrics, Karolinska University HospitalAstrid Lindgren Children's HospitalStockholmSweden
| | - Ulrika Kreicbergs
- Department of Women's and Children's Health, Childhood Cancer Research UnitKarolinska InstitutetStockholmSweden
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
- Advanced Pediatric Home CareKarolinska University HospitalStockholmSweden
| | - Klara Wallén
- Division of Pediatrics, Karolinska University HospitalAstrid Lindgren Children's HospitalStockholmSweden
| | - Jennie Ekman
- Division of Pediatrics, Karolinska University HospitalAstrid Lindgren Children's HospitalStockholmSweden
| | - Synnöve Lindemalm
- Division of Pediatrics, Karolinska University HospitalAstrid Lindgren Children's HospitalStockholmSweden
- Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
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6
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Offenbacher R, Briggs J, Ronca K, Uong A, Ogidan-Odeseye O, Kim M, Weiser D. Retention of discharge instructions using an interdisciplinary model for at-risk children with cancer: A quality improvement initiative. Pediatr Blood Cancer 2023; 70:e30045. [PMID: 36215215 DOI: 10.1002/pbc.30045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE We sought to improve caregiver retention of critical initial hospital discharge instructions using a multidisciplinary, team-based intervention for newly diagnosed pediatric cancer patients at high risk for unfavorable outcomes. MATERIALS AND METHODS A multidisciplinary team of pediatric residents, nurses, social workers, pharmacists and hematology/oncology faculty implemented practices to optimize teaching of key discharge material as part of four Plan-Do-Study-Act intervention cycles. An 11-question survey distributed at the first post-discharge clinic visit assessed the efficacy of the intervention, as defined by caregiver retention of critical home instructions. RESULTS Thirty-nine caregivers of pediatric cancer patients in an urban academic tertiary-care children's hospital took part in this project. Overall retention of key discharge information was greater in the post-intervention cohort compared to the baseline cohort (median total scores: 89 and 63, respectively; p = .001). Improvements in the proportions of correct responses post-intervention were also observed across all subject matters: from 0.57 to 0.88 for fever guidelines (p = .059), from 0.71 to 0.78 for signs of sepsis (p = .65), from 0.57 to 1.00 for accurate choice of on-call number (p = .004), and from 0.71 to 0.94 for antiemetic management (p = .14). CONCLUSION Initiation of our comprehensive cancer-specific program to improve caregiver retention of discharge instructions at the first post-hospitalization clinic visit has been successful and sustainable. This project demonstrated that a multi-disciplinary collaborative team effort increases caregiver retention of critical health information, and this has potential to lead to improved outcomes for patients.
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Affiliation(s)
| | | | - Kristen Ronca
- Children's Hospital at Montefiore, Bronx, New York, USA
| | - Audrey Uong
- Children's Hospital at Montefiore, Bronx, New York, USA
| | | | - Mimi Kim
- Department of Epidemiology & Population Health Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Weiser
- Children's Hospital at Montefiore, Bronx, New York, USA.,Departments of Pediatrics and Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
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7
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Using failure mode and Effects Analysis to increase patient safety in cancer chemotherapy. Res Social Adm Pharm 2021; 18:3386-3393. [PMID: 34838476 DOI: 10.1016/j.sapharm.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/16/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Medication errors may occur during chemotherapy and can have fatal consequences. Healthcare Failure Mode and Effects Analysis (FMEA) is a method used to detect potential risks and prevent them. OBJECTIVE Aim of this study was to evaluate the medication process of intravenous tumor therapy in order to guarantee a high standard of patient safety. METHODS The main part of the study was performed at the University Hospital of Bonn, Germany. After assembling a multidisciplinary team, the individual steps of prescription, compounding, transport, and administration of chemotherapy were mapped in a flow diagram. The possible failures were identified and analyzed by calculating the risk priority numbers (RPNs). Finally, corrective actions were developed and after hypothetical implementation re-analyzed to measure their effects on the process. Subsequently, a shortened FMEA based on the catalogue failure modes developed in Bonn was carried out at the University Hospital of Cologne in order to evaluate its transferability to another hospital. RESULTS A total of 52 potential failure modes was identified in Bonn. Relating to the RPNs the most critically steps in the process were associated with the prescription, namely, incorrect information about individual parameters of the patient; non-standardized chemotherapy protocols; and problems related to supportive therapy. A significant risk reduction for most of the failure modes was assessed by implementing suitable corrective actions. The shortened FMEA in Cologne led to a different ranking of failure modes. CONCLUSION The implementation of this analysis has not only identified various safety gaps, but also shows how patient safety during chemotherapy can be enhanced. Moreover, it has sensitized the practitioners to failure modes potentially occurring in their work routine.
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8
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Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res 2021; 21:342. [PMID: 33853610 PMCID: PMC8048073 DOI: 10.1186/s12913-021-06254-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. METHODS We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. RESULTS The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. CONCLUSION The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. TRIAL REGISTRATION Prospero ID: CRD42017082140.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
| | - James Barlow
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Liz Evans
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
| | - Julie Reed
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
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9
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Lichtner V, Baysari M, Gates P, Dalla-Pozza L, Westbrook JI. Medication safety incidents in paediatric oncology after electronic medication management system implementation. Eur J Cancer Care (Engl) 2019; 28:e13152. [PMID: 31436876 PMCID: PMC7161912 DOI: 10.1111/ecc.13152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
Objective To explore medication safety issues related to use of an electronic medication management system (EMM) in paediatric oncology practice, through the analysis of patient safety incident reports. Methods We analysed 827 voluntarily reported incidents relating to oncology patients that occurred over an 18‐month period immediately following implementation of an EMM in a paediatric hospital in Australia. We identified medication‐related and EMM‐related incidents and carried out a content analysis to identify patterns. Results We found ~79% (n = 651) of incidents were medication‐related and, of these, ~45% (n = 294) were EMM‐related. Medication‐related incidents included issues with: prescribing; dispensing; administration; patient transfers; missing chemotherapy protocols and information on current stage of patient treatment; coordination of chemotherapy administration; handling or storing medications; children or families handling medications. EMM‐related incidents were classified into four groups: technical issues, issues with the user experience, unanticipated problems in EMM workflow, and missing safety features. Conclusions Incidents reflected difficulties with managing therapies rich in interdependencies. EMM, and especially its ‘automaticity’, contributed to these incidents. As EMM impacts on safety in such high‐risk settings, it is essential that users are aware of and attend to EMM automatic behaviours and are equipped to troubleshoot them.
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Affiliation(s)
- Valentina Lichtner
- Department of Practice and Policy, School of Pharmacy, UCL, London, UK.,Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
| | - Melissa Baysari
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia.,Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Peter Gates
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children Hospital at Westmead, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
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10
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Patient Involvement in Evaluation of Safety in Oral Antineoplastic Treatment: A Failure Mode and Effects Analysis in Patients and Health Care Professionals. Qual Manag Health Care 2019; 28:33-38. [PMID: 30586120 DOI: 10.1097/qmh.0000000000000199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify risks associated with delivery of treatment with oral antineoplastic agents in an outpatient setting and to evaluate additional value and feasibility of engaging patients in a proactive risk analysis. METHODS We conducted 2 separate but parallel failure mode and effects analyses (FMEAs) among patients and health care professionals (HCPs) at a clinical oncology department in Denmark. Comparative analyses were performed using the FMEA process maps and risk priority numbers (RPNs) as main outcome measures. The FMEAs were augmented by semistructured interviews with HCPs and patients on acceptability and feasibility of FMEAs analyzed using systematic text condensation. RESULTS Patients and HCPs found failures in information regarding treatment (cause, aim, and plan) to be of high risk. Also, HCPs found failures in checking for potential interactions to be of high risk. HCPs focused on the in-hospitals procedures, whereas patients identified risks related to both the hospital and the home setting. Both HCPs and patients found participation in the FMEA process meaningful but found the use of RPNs difficult. CONCLUSIONS Patient engagement in proactive risk analysis using FMEA is acceptable, meaningful, and feasible, with patients providing a different perspective on the risks associated with oral antineoplastic treatment compared with HCPs.
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11
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Hoffman JM, Keeling NJ, Forrest CB, Tubbs-Cooley HL, Moore E, Oehler E, Wilson S, Schainker E, Walsh KE. Priorities for Pediatric Patient Safety Research. Pediatrics 2019; 143:e20180496. [PMID: 30674609 PMCID: PMC6361358 DOI: 10.1542/peds.2018-0496] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 12/14/2022] Open
Abstract
: media-1vid110.1542/5972296743001PEDS-VA_2018-0496Video Abstract BACKGROUND: Developing a research agenda that is focused on the priorities of key stakeholders may expedite implementation and dissemination. Our objective was to identify the highest-priority patient-safety research topics among pediatric clinicians, health care leaders, and families. METHODS The Children's Hospitals Solutions for Patient Safety Network is a network of >100 children's hospitals working together to eliminate harm due to health care. Parents and site leaders responded to an open-ended, anonymous e-mail survey used to elicit research topics. A key stakeholder panel winnowed related topics and prioritized topics using Likert scale ratings. Site leaders and parents responded to a second anonymous e-mail survey and rated the importance of each topic. Health system executive interviews were used to elicit their opinions regarding top priorities for patient-safety research. RESULTS The elicitation survey had 107 respondents who produced 49 unique research topics. The key stakeholder panel developed a final list of 24 topics. The prioritization survey had 74 respondents. Top-priority research topics concerned high reliability, safety culture, open communication, and early detection of patient deterioration and sepsis. During 7 qualitative interviews, health system executives highlighted diagnostic error, medication safety, deterioration, and ambulatory patient safety as priority areas. CONCLUSIONS With this study, we take a first step toward a stakeholder-driven research agenda on the basis of the assumption that stakeholders are best positioned to determine what research will be used to address the problems of most concern to them.
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Affiliation(s)
- James M Hoffman
- Department of Pharmaceutical Sciences and
- Office of Quality and Patient Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Nicholas J Keeling
- Department of Pharmaceutical Sciences and
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, Mississippi
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather L Tubbs-Cooley
- Division of Nursing, Research in Patient Services
- James M. Anderson Center of Health Systems Excellence, and
| | - Erin Moore
- Department of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily Oehler
- James M. Anderson Center of Health Systems Excellence, and
| | | | | | - Kathleen E Walsh
- James M. Anderson Center of Health Systems Excellence, and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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12
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Broder-Fingert S, Qin S, Goupil J, Rosenberg J, Augustyn M, Blum N, Bennett A, Weitzman C, Guevara JP, Fenick A, Silverstein M, Feinberg E. A mixed-methods process evaluation of Family Navigation implementation for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1288-1299. [PMID: 30404548 DOI: 10.1177/1362361318808460] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is growing interest in Family Navigation as an approach to improving access to care for children with autism spectrum disorder, yet little data exist on the implementation of Family Navigation. The aim of this study was to identify potential failures in implementing Family Navigation for children with autism spectrum disorder, using a failure modes and effects analysis. This mixed-methods study was set within a randomized controlled trial testing the effectiveness of Family Navigation in reducing the time from screening to diagnosis and treatment for autism spectrum disorder across three states. Using standard failure modes and effects analysis methodology, experts in Family Navigation for autism spectrum disorder (n = 9) rated potential failures in implementation on a 10-point scale in three categories: likelihood of the failure occurring, likelihood of not detecting the failure, and severity of failure. Ratings were then used to create a risk priority number for each failure. The failure modes and effects analysis detected five areas for potential "high priority" failures in implementation: (1) setting up community-based services, (2) initial family meeting, (3) training, (4) fidelity monitoring, and (5) attending testing appointments. Reasons for failure included families not receptive, scheduling, and insufficient training time. The process with the highest risk profile was "setting up community-based services." Failure in "attending testing appointment" was rated as the most severe potential failure. A number of potential failures in Family Navigation implementation-along with strategies for mitigation-were identified. These data can guide those working to implement Family Navigation for children with autism spectrum disorder.
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Affiliation(s)
| | - Sarah Qin
- 2 The Children's Hospital of Philadelphia, USA
| | | | | | | | | | | | | | | | | | | | - Emily Feinberg
- 1 Boston University School of Medicine, USA.,5 Boston University School of Public Health, USA
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13
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Demers É, Collin-Lévesque L, Boulé M, Lachapelle S, Nguyen C, Lebel D, Bussières JF. Analyse des modes de défaillance, de leurs effets et de leur criticité dans le circuit du médicament: revue de littérature. Can J Hosp Pharm 2018; 71:376-384. [PMID: 30626984 PMCID: PMC6306183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Failure mode, effects, and criticality analysis (FMECA) is a systematic and proactive risk analysis method to determine major failures in complex processes. OBJECTIVE To identify all articles involving the use of failure mode and effects analysis (FMEA), FMECA, or FMECA in health care within the medication use system. DATA SOURCES STUDY SELECTION AND DATA EXTRACTION The MEDLINE database was searched, for the period January 1990 to January 2017. The search included studies using the FMECA method, in part or in full, and dealing with one or several components of the medication use system. The reference lists of articles identified in the initial search were checked manually for additional pertinent references. DATA SYNTHESIS The researchers identified 171 articles, and retained 39 for analysis: 32 describing use of the FMEA or FMECA approach and 7 describing use of the FMECA in health care approach. They identified between 4 to 378 failure modes, according to the published studies. Among the 39 articles, 10 reported a pre- and post-implementation analysis of corrective measures. In 4 of those 10 articles, the analysis was conducted on a theoretical basis, that is, before the corrective measures were actually implemented. Using the articles retained for analysis, a summary table was developed with the following elements: publication year, main author, country, primary objective, secondary objectives, descriptions of both method and results, and comments. The summary table gave the opportunity to comment on the use of the FMECA-type analysis within the medication use system. CONCLUSIONS This literature review included 39 published articles using an FMEA, FMECA, or FMECA in health care approach within the medication use system. Most studies used either the FMEA or the FMECA approach, whereas the FMECA in health care approach was used only rarely. Only a minority of studies assessed the effects of corrective measures that were implemented. This overall approach allows for mapping of a care process, determination of failure modes, and prioritization of corrective measures. Its use for the assessment of the medication use system should be promoted.
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Affiliation(s)
- Émile Demers
- Pharm. D., M. Sc., est résident en pharmacie, Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Laurence Collin-Lévesque
- Pharm. D., M. Sc., est résident en pharmacie, Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Marianne Boulé
- Pharm. D., M. Sc., est résidente en pharmacie, Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Sophie Lachapelle
- Pharm. D., M. Sc., est résidente en pharmacie, Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Christina Nguyen
- B. Sc., M. Sc., est pharmacienne, Unité de recherche en pratique pharmaceutique et département de pharmacie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Denis Lebel
- B. Pharm., M. Sc., FCSHP, est Adjoint au chef, Unité de recherche en pratique pharmaceutique et département de pharmacie, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec
| | - Jean-François Bussières
- B. Pharm., M. Sc., M. B. A., FCSHP, FOPQ, est Chef, Unité de recherche en pratique pharmaceutique et département de pharmacie, Centre hospitalier universitaire Sainte-Justine, et professeur titulaire de clinique, Faculté de pharmacie, Université de Montréal, Montréal, Québec
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14
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Abstract
Background: High-risk infants transitioning from the neonatal intensive care unit (NICU) to home represent a vulnerable population, given their complex care requirements. Little is known about errors during this period. Purpose: Identify and describe homecare and healthcare utilization errors in high-risk infants following NICU discharge. Methods: This was a prospective observational cohort study of homecare (feeding, medication, and equipment) and healthcare utilization (appointment) errors in infants discharged from a regional NICU between 2011 and 2015. Chi-square test and Wilcoxon rank-sum test were used to compare infant and maternal demographics between infants with and without errors. Results: A total of 363 errors were identified in 241 infants during 635 home visits. The median number of visits was 2. No significance was found between infant and maternal demographics in those with or without errors. Implications of Practice: High-risk infants have complex care needs and can benefit from regular follow-up services. Home visits provide an opportunity to identify, intervene, and resolve homecare and healthcare utilization errors. Implications of Research: Further research is needed to evaluate the prevalence and cause of homecare errors in high-risk infants and how healthcare resources and infant health outcomes are affected by those errors. Preventive measures and mitigating interventions that best address homecare errors require further development and subsequent description.
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15
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Asgari Dastjerdi H, Khorasani E, Yarmohammadian MH, Ahmadzade MS. Evaluating the application of failure mode and effects analysis technique in hospital wards: a systematic review. J Inj Violence Res 2017; 9:794. [PMID: 28039688 PMCID: PMC5279992 DOI: 10.5249/jivr.v9i1.794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/19/2016] [Indexed: 11/06/2022] Open
Abstract
Background: Medical errors are one of the greatest problems in any healthcare systems. The best way to prevent such problems is errors identification and their roots. Failure Mode and Effects Analysis (FMEA) technique is a prospective risk analysis method. This study is a review of risk analysis using FMEA technique in different hospital wards and departments. Methods: This paper has systematically investigated the available databases. After selecting inclusion and exclusion criteria, the related studies were found. This selection was made in two steps. First, the abstracts and titles were investigated by the researchers and, after omitting papers which did not meet the inclusion criteria, 22 papers were finally selected and the text was thoroughly examined. At the end, the results were obtained. Results: The examined papers had focused mostly on the process and had been conducted in the pediatric wards and radiology departments, and most participants were nursing staffs. Many of these papers attempted to express almost all the steps of model implementation; and after implementing the strategies and interventions, the Risk Priority Number (RPN) was calculated to determine the degree of the technique’s effect. However, these papers have paid less attention to the identification of risk effects. Conclusions: The study revealed that a small number of studies had failed to show the FMEA technique effects. In general, however, most of the studies recommended this technique and had considered it a useful and efficient method in reducing the number of risks and improving service quality.
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Affiliation(s)
| | - Elahe Khorasani
- School of Pharmacy, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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16
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Santos-Rubio MD, Marín-Gil R, Muñoz-de la Corte R, Velázquez-López MD, Gil-Navarro MV, Bautista-Paloma FJ. [Failure mode effect analysis applied to preparation of intravenous cytostatics]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2015; 31:106-12. [PMID: 26476875 DOI: 10.1016/j.cali.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/04/2015] [Accepted: 07/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To proactively identify risks in the preparation of intravenous cytostatic drugs, and to prioritise and establish measures to improve safety procedures. MATERIAL AND METHODS Failure Mode Effect Analysis methodology was used. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. The impact associated with each failure mode was assessed with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for all identified failure modes, with those with RPN>100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated and the process was redesigned. RESULTS A total of 34 failure modes were identified. The initial accumulated RPN was 3022 (range: 3-252), and after recommended actions the final RPN was 1292 (range: 3-189). RPN scores >100 were obtained in 13 failure modes; only the dispensing sub-process was free of critical points (RPN>100). A final reduction of RPN>50% was achieved in 9 failure modes. CONCLUSIONS This prospective risk analysis methodology allows the weaknesses of the procedure to be prioritised, optimize use of resources, and a substantial improvement in the safety of the preparation of cytostatic drugs through the introduction of double checking and intermediate product labelling.
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Affiliation(s)
- M D Santos-Rubio
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R Marín-Gil
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Muñoz-de la Corte
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M D Velázquez-López
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M V Gil-Navarro
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F J Bautista-Paloma
- Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario Virgen del Rocío, Sevilla, España
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17
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Walsh KE, Cutrona SL, Kavanagh PL, Crosby LE, Malone C, Lobner K, Bundy DG. Medication adherence among pediatric patients with sickle cell disease: a systematic review. Pediatrics 2014; 134:1175-83. [PMID: 25404717 PMCID: PMC4243064 DOI: 10.1542/peds.2014-0177] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Describe rates of adherence for sickle cell disease (SCD) medications, identify patient and medication characteristics associated with nonadherence, and determine the effect of nonadherence and moderate adherence (defined as taking 60%-80% of doses) on clinical outcomes. METHODS In February 2012 we systematically searched 6 databases for peer-reviewed articles published after 1940. We identified articles evaluating medication adherence among patients <25 years old with SCD. Two authors reviewed each article to determine whether it should be included. Two authors extracted data, including medication studied, adherence measures used, rates of adherence, and barriers to adherence. RESULTS Of 24 articles in the final review, 23 focused on 1 medication type: antibiotic prophylaxis (13 articles), iron chelation (5 articles), or hydroxyurea (5 articles). Adherence rates ranged from 16% to 89%; most reported moderate adherence. Medication factors contributed to adherence. For example, prophylactic antibiotic adherence was better with intramuscular than oral administration. Barriers included fear of side effects, incorrect dosing, and forgetting. Nonadherence was associated with more vaso-occlusive crises and hospitalizations. The limited data available on moderate adherence to iron chelation and hydroxyurea indicates some clinical benefit. CONCLUSIONS Moderate adherence is typical among pediatric patients with SCD. Multicomponent interventions are needed to optimally deliver life-changing medications to these children and should include routine monitoring of adherence, support to prevent mistakes, and education to improve understanding of medication risks and benefits.
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Affiliation(s)
- Kathleen E. Walsh
- Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio;,Departments of Pediatrics, and,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Sarah L. Cutrona
- Medicine, University of Massachusetts, Worcester, Massachusetts;,Meyers Primary Care Institute, Worcester, Massachusetts
| | | | - Lori E. Crosby
- Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Chris Malone
- Meyers Primary Care Institute, Worcester, Massachusetts
| | - Katie Lobner
- Welch Medical Library, Johns Hopkins Medical Center, Baltimore, Maryland; and
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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18
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Oberoi S, Trehan A, Marwaha RK. Medication errors on oral chemotherapy in children with acute lymphoblastic leukemia in a developing country. Pediatr Blood Cancer 2014; 61:2218-22. [PMID: 25175850 DOI: 10.1002/pbc.25203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 07/07/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication errors occur universally. Inappropriate administration of chemotherapy drugs can have adverse effects in cancer patients. Our objective was to assess the rate and type of medication errors in children with acute lymphoblastic leukemia (ALL) receiving oral chemotherapy in outpatient setting. PROCEDURE Prescription and administration of oral chemotherapy drugs in children with ALL were evaluated prospectively to determine rate and type of medication errors. Errors were defined as prescription (physician) level or administration (patient) level errors. RESULTS Two hundred eighty-nine drugs were prescribed to 121 patients. Medication errors occurred in 36 (12.5%) prescriptions; 21(7.3%) were administration errors, 13 (4.5%) were prescribing errors, and two errors occurred at both levels. Mercaptopurine (6-MP) was significantly associated with higher rates of errors (Odds ratio [OR] = 2.1, 95% CI [confidence interval] 1-4.1) whereas lapses were less with dexamethasone (OR = 0.25, 95% CI 0.09-0.67). As a result of medication errors 28 (23.1%) patients received inappropriate doses. Twenty five (21%) patients received sub-optimal doses whereas three got higher doses of chemotherapy. On univariate analysis, socioeconomic status, education status of the caregiver, 6-MP and methotrexate were significantly associated with errors (P ≤ 0.05). On multivariate analysis, ≤ primary school education of the caregiver and prescription of methotrexate were independent predictors of errors. CONCLUSIONS Medication errors affected nearly one fourth of the children receiving oral chemotherapy. Future studies are needed to look at effective interventions to avoid chemotherapy associated errors especially amongst the lower strata of society.
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Affiliation(s)
- Sapna Oberoi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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19
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Walsh KE, Biggins C, Blasko D, Christiansen SM, Fischer SH, Keuker C, Klugman R, Mazor KM. Home medication support for childhood cancer: family-centered design and testing. J Oncol Pract 2014; 10:373-6. [PMID: 25336081 DOI: 10.1200/jop.2014.001482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. METHODS We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. RESULTS We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. CONCLUSION We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study.
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Affiliation(s)
- Kathleen E Walsh
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Colleen Biggins
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Deb Blasko
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Steven M Christiansen
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Shira H Fischer
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Christopher Keuker
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Robert Klugman
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Kathleen M Mazor
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
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20
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Abstract
Exposure to chemotherapy is a health hazard for all personnel in facilities that store, prepare, or administer antineoplastic agents. Contamination levels have been measured as much as 15 times higher in the veterinary medicine sector than in human facilities. Recent publications in human and veterinary medicine indicate that exposure extends beyond the clinic walls to affect the patient's home and family. This article provides an update on the advances in chemotherapy safety, the current issues, and the impact on cancer management in veterinary medicine.
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Affiliation(s)
- Shawna Klahn
- Department of Small Animal Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA 24061, USA.
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21
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Walsh KE, Roblin DW, Weingart SN, Houlahan KE, Degar B, Billett A, Keuker C, Biggins C, Li J, Wasilewski K, Mazor KM. Medication errors in the home: a multisite study of children with cancer. Pediatrics 2013; 131:e1405-14. [PMID: 23629608 PMCID: PMC4074655 DOI: 10.1542/peds.2012-2434] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer. METHODS In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites. RESULTS We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40-121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9-81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7-5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3-43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy. CONCLUSIONS Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients.
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Affiliation(s)
- Kathleen E Walsh
- Departments of Pediatrics, University of Massachusetts School of Medicine, Worcester, MA 01655, USA.
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