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Key partner priorities for measures of safe outpatient paediatric medication use
Jonelle Prideaux1,2, Maria T Britto3,4, Lisa M Vaughn5,6
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Developing measures for safe paediatric outpatient medication administration at home is crucial. Parents and healthcare professionals prioritized these, highlighting the need for caregiver involvement in quality improvement.
Area of Science:
- Pediatric pharmacology
- Medication safety research
- Health services research
Background:
- Pediatric outpatient medication use is prone to errors due to complex dosing and administration.
- Current measurement of medication errors in outpatient settings is insufficient for quality improvement.
- Collaboration with stakeholders is essential to identify and develop necessary measurement tools.
Purpose of the Study:
- To identify essential measures for assessing pediatric outpatient medication errors.
- To involve key partners, including patients and families, in defining measurement priorities.
- To address gaps in current measurement approaches for medication errors in home settings.
Main Methods:
- Qualitative interviews were conducted with parents, pharmacists, pediatricians, nurses, and leaders.
- Concept mapping, a structured survey and analysis process, was used to generate and prioritize measures.
- Data from interviews and concept mapping were compared to identify common themes and priorities.
Main Results:
- Seven key clusters of medication errors were identified: prescribing, administration, dispensing, dosing/education, monitoring, surveillance, and family partnership.
- Stakeholders prioritized health system measures for safe outpatient medication use and quality improvement.
- Feasible measures for home administration, dispensing errors, harm, and data segmentation by high-risk populations were highlighted.
Conclusions:
- Measures for safe home medication administration are the highest priority for both parents and healthcare professionals.
- Scalable measures for home administration are currently unavailable and urgently needed.
- Future measurement tools will likely incorporate caregiver reports to capture home-based medication events.
Background And Objectives:
Paediatric medication use is at high risk for errors due to factors such as weight-based dosing and liquid medications. In the outpatient setting, where most children take their medicines, errors are common and can be dangerous. However, errors are not widely measured in this setting. Continuous measurement is the first step towards quality improvement. Our aim was to collaborate with a variety of professional and patient/family key partners to identify types of measures needed to assess paediatric outpatient medication errors, including those that occur in the home.
Methods:
We conducted qualitative interviews and concept mapping with parents, pharmacists, paediatricians, nurses, health system leaders and healthcare organisational leaders. Using concept mapping, a multiple-step structured process of surveys, sorting and analysis using multidimensional scaling and hierarchical cluster analysis, participants generated measures and prioritised those they considered most important and feasible to measure in future medication error instruments. At the same time, interviews identified gaps in current measurement approaches and top priorities to fill these gaps. Results were compared during analysis.
Results:
Concept mapping participants (n=71) contributed ideas which key partner panel (n=9) mapped into seven clusters: prescribing errors, giving medication/administration, pharmacy dispensing, dosing tools and education, monitoring for problems, error surveillance and family partnership in understanding errors. Interview participants (n=24) highlighted the need for health system measures of safe outpatient medication used for quality improvement, including feasible measures related to home administration, dispensing errors and measures of harm. The ability to segment data by high-risk populations (eg, preferred language) was a priority.
Conclusions:
Measures of safe administration at home were the highest priority for parents and healthcare professionals. Development of these measures is critical as no scalable measures for this element of care are available. These and other prioritised measures will likely need to include caregiver report.
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