Question

The Pediatric patient in the health field

Answer 1

Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report “To Err Is Human: Building a Safer Health System” in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children.

To help create and propel a comprehensive, accelerated approach toward pediatric patient safety, the following recommendations are made for all pediatricians and other health care providers and organizations caring for children:

1. Raise awareness and improve working knowledge of pediatric patient safety issues and best practices throughout the pediatric community.

   1. Educate and train: Expand interprofessional educational efforts to reach a broad scope of clinicians. Support structures that allow for all clinicians to identify pediatric patient safety issues and describe what they can do to improve them both individually and within systems. Include patient safety curricula for all child health trainees. Emphasize the importance of communication among teams, with patients and parents, and with referring providers.

   2. Network: Participate in available patient safety programming at national and regional meetings to encourage the sharing of patient safety issues and best practices among pediatric clinicians.

   3. Create a safety culture: Challenge all organizations, including practices of all sizes that care for children, to adopt a plan that informs, supports, and educates on pediatric patient safety. Use appropriate local examples of improvements initiated because of errors or “good catches” in which harms were avoided to create a safety culture. Strive to develop programs that support members to improve their safety culture in their clinical care settings. Start any group meeting with a 2- to 3-minute “safety story” from your own practice that highlights “good catch” or real-harm events from which we can learn.

   4. Implement and use standardized protocols of care for specific conditions, such as checklists or clinical practice guidelines, and monitor adherence.

   5. Expand focus: Direct the attention of pediatric health care providers to safety in ambulatory settings, including the family-centered medical home and other locations where children receive care. Develop patient safety metrics for the ambulatory pediatric setting, including the home and school environments.

2. Act and advocate to minimize preventable pediatric medical harm by using information on pediatric-specific patient-safety risks.

   1. Develop pediatric-specific error reporting: In collaboration with governmental and private entities, develop and support broad-scale pediatric error-reporting systems and analysis of submitted events. Establish nonpunitive medical error-reporting systems in pediatric practices and on interprofessional teams to review and act on reported errors. Identify trends and areas in need of action by using these data to guide action on pediatric patient safety risks.

   2. Foster leadership: Take individual responsibility for maintaining awareness of pediatric patient safety issues. When possible, lead or participate in practice-based safety initiatives and quality or patient-safety committees in any setting, including ambulatory, hospital-based, community, or tertiary-care centers. Spread the current hospital-based focus on patient safety to the ambulatory setting through the designation of patient safety champions for practices.

   3. Enhance family-centered care, actively engage patients and families in safety at all points of care, and address issues of ethnic culture, language, and health literacy. Direct families to appropriate resources, and review patients’ rights and responsibilities from the perspective of safety. Involve families in identifying, creating, and implementing patient safety best practices with attention to the medical home model in the ambulatory setting. Engage families in creating safety materials and participating in safety committees. Identify opportunities for families to aid in improvements related to health literacy, handoffs, and school and home care, among others. Leverage EHR portals and tools to directly communicate and share materials with patients and families.

3. Improve health care outcomes for children by adhering to proven best practices for improving pediatric patient safety.

   1. Adhere to best practices: Disseminate and exercise proven patient safety interventions, such as vigilant hand-washing, timeouts before procedures, and rigorous patient identification processes and medication reconciliation, particularly in ambulatory settings and for children with special health care needs. Embed safety strategies, such as redundancy, forcing functions, barcoding, standardized order sets, and evidence-based clinical practice guidelines (Appendix) whenever possible. Consider using data from national medical liability carriers to help identify areas of research regarding medical errors and patient safety.

   2. Target drug safety: In collaboration with regulatory agencies, focus efforts on medication safety by advocating for the development and study of effective and safe pediatric medications and formulations and for the withdrawal of medications with unfavorable risk/benefit ratios; promoting the standardization of concentrations in compounded medications; developing, spreading, and advocating for pediatric-specific health care information technology for drug delivery; educating providers on methods to reduce medication errors, including medication reconciliation; ensuring that providers maintain access to and proficiency in the use of a comprehensive and current pharmaceutical knowledge base; and creating policies that advocate for safe medication delivery to children in all health care settings, including effective liquid measurement devices coupled with teach-back and other advanced counseling techniques.

   3. If in a position to do so, help redesign clinical systems: Instill safety-design concepts when renovating or creating medical care systems and processes. Focus on human-factor issues in patient safety and include pediatric-specific information technological advancements whenever possible (eg, when implementing barcoding and CPOE systems). Partner with and urge government and other agencies and industries to identify, test, share, and study information systems that support the unique needs of the pediatric population. Support a change from the current “1 facility at a time,” pediatric-specific EHR improvements that result in variations across organizations to meaningful vendor engagement in creating a united pediatric platform that is available equitably across care settings and users.

   4. Leadership: Support and expand research to identify and refine effective pediatric patient safety interventions and study how information technology and human factors affect health care teams and the care they deliver. Motivate national health care research-funding systems to include a mandatory pediatric patient safety component.