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Published on: August 30, 2018
Characteristics of adverse medication events in a children's hospital
Sonya Stacey1, Ian Coombes, Claire Wainwright
1Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia; Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.
Insights
International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) coding captured 85% of harm-related adverse medication events (AMEs) in children. Reviewing ICD-10 coded AMEs improves patient safety and quality of care.
Area of Science:
- Pediatric Patient Safety
- Medication Error Surveillance
- Health Informatics
Background:
- Adverse medication events (AMEs) in children pose significant risks to patient safety.
- Accurate identification and reporting of AMEs are crucial for implementing effective safety measures.
- Existing data sources for AME reporting may have varying levels of completeness and accuracy.
Purpose of the Study:
- To compare the reporting of pediatric AMEs using International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes versus other data sources.
- To assess the proportion of harm-related AMEs captured by ICD-10 coding.
- To evaluate the documentation of AMEs in clinical alerts.
Main Methods:
- Retrieved AME reports using ICD-10 codes (Y40-Y59, X40-X44) over a six-month period.
- Manually reviewed patient charts to identify medication-related errors and harm during hospital admissions.
- Collected data on medication details, error, harm, and alert documentation, and reviewed clinical incidents and pharmacist interventions.
Main Results:
- ICD-10 coding identified 146 AMEs in 180 children, while other sources reported 117 incidents and 190 pharmacist interventions, totaling 447 events across all sources.
- Of 158 harm-related events, ICD-10 coding captured 135 (85%), with minimal overlap between data sources.
- Errors were noted in 3% of ICD-10 reports, 97% of incidents, and 100% of interventions; only 14% of ICD-10 harm events were documented in clinical alerts.
Conclusions:
- ICD-10 coding is a valuable tool for documenting a substantial majority of harm-related AMEs in pediatric patients.
- The findings highlight the potential of ICD-10 coded AME data to enhance patient safety initiatives.
- Further integration and analysis of ICD-10 coded AME data can lead to improved quality of care in pediatric settings.
Aim:
To compare adverse medication events (AMEs) reported in children, via the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) coding with events reported via other data sources.
Method:
AME reports were retrieved using codes Y40-Y59 and X40-X44 over 6 months. Patients' charts were manually reviewed to identify events associated with error and/or harm with medicines during a hospital admission. Medication name, group, error, harm and alert documentation were recorded. Clinical incidents and pharmacist interventions were reviewed for the same period.
Results:
Two hundred sixty-three events from January to June 2011 were recorded by ICD-10 coding in 180 patients. After duplicated, missing or unrelated events were excluded and 146 AMEs remained. In the same period, 117 AMEs were reported as incidents and 190 as pharmacist interventions. In total, 276 children with 447 events were reported via all sources. Little duplication between data sources was evident. In total, 158 events involved harm, with 135 of these from ICD-10 coding, 16 from incident reports and 2 pharmacist interventions (including 6 events from multiple sources). Error was involved in 3% of ICD10 reports, 97% of incidents and 100% of interventions. Only 14% of harm-related events from ICD-10 were documented on the medical record clinical alert. Chemotherapy accounted for 31% of harm-related events, antimicrobials 18%, corticosteroids 14% and narcotics 12%.
Conclusion:
Of the harm-related events, 85% were documented via ICD-10 coding with few documented in other databases. Review of ICD-10-coded AMEs can provide valuable information to improve patient safety and quality.
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