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Optimizing Medication Safety Review and Adverse Drug Events: A Quality Improvement Study
Elizabeth Haines1,2,3, Rebecca Malizia3, Roban Shabbir1
1Department of Pediatrics, New York University Langone Health, New York.
Insights
This study improved medication safety for high-alert medications in children, increasing the time between adverse events. Efforts to reduce nephrotoxic medication events require further intervention.
Area of Science:
- Pediatric Patient Safety
- Medication Error Reduction
- Quality Improvement in Healthcare
Background:
- Children are vulnerable to adverse drug events, particularly with high-alert and nephrotoxic medications.
- Reducing the frequency of these medication safety events is a critical healthcare objective.
Purpose of the Study:
- To decrease the interval between reported medication safety events involving high-alert and nephrotoxic drugs by 5% over 28 months.
- To enhance patient safety in pediatric care settings through targeted quality improvement initiatives.
Main Methods:
- A single-center quality improvement study involving 1 acute care and 3 intensive care units.
- Interventions included provider education, medication list targeting, and rounding audits.
- Statistical process control charts analyzed the time between medication safety events.
Main Results:
- A significant increase in the number of days between high-alert medication events was observed (10-day decrease in interval).
- No significant change in the interval for nephrotoxic medication events was detected.
- Process compliance for high-alert medication bundles averaged 90%, while nephrotoxic bundles averaged 76%.
Conclusions:
- The study successfully increased the time between high-alert medication events.
- Sustained improvement for nephrotoxic medication events necessitates further interventions.
- Continued monitoring and integration of electronic health record changes are recommended for future efforts.
Objective:
Children are susceptible to adverse drug events, especially those related to high-alert and nephrotoxic medications. This study aimed to reduce the number of days in between reported medication safety events related to high-alert and nephrotoxic medications by 5% over a 28-month period.
Patients And Methods:
This single-center quality improvement study at an urban academic institution occurred across 1 acute care and 3 intensive care units. Interventions focused on increased emphasis on these medications (targeted medication list, rounding script modifications, and provider education), review of medication orders, and rounding audits. Outcomes were the number of days in between events for high-alert and nephrotoxic medications (manual review of events from the event reporting system). Process measures included bundles related to high-alert and nephrotoxic medications (eg, knowledge and discussion of elements) observed during rounds. Metrics were analyzed using statistical process control G charts and run charts.
Results:
The number of days in between events related to high-alert medications decreased by 10 days; a centerline shift was observed. No centerline shifts were noted for nephrotoxic medications. Special cause variation was noted with more days in between events in the final year of the study period for both high-alert and nephrotoxic medications. Mean process compliance for the high-alert bundle was 90% (monthly range, 67%-100%) and 76% (monthly range, 25%-100%) for the nephrotoxic bundle.
Conclusions:
Time in between high-alert medication event rates increased; process compliance varied but was unchanged overall. Future work should focus on continued tracking of metrics and incorporating additional interventions, including electronic health record changes.
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