October 27, 2011

Pediatric quality initiative reduces harmful drug effects

Pediatric quality initiative reduces harmful drug effects

The Monroe Carell Jr. Children's Hospital at Vanderbilt outperformed 12 other children’s hospitals in a yearlong quality improvement project to reduce the number of harmful drug effects in pediatric patients.

Children’s Hospital exceeded expectations with an 88 percent reduction in adverse drug events, when a therapeutic medication causes injury or harm to a person. Up to 35 percent of these events can be serious or life-threatening.

The hospital surpassed the project goal to reach 50 percent reduction.

Children’s Hospital participated in a 13-hospital quality improvement project to reduce adverse drug effects in children from July 2008 to June 2009. The project results, published recently in the journal Pediatrics, showed that collectively the hospitals decreased ADEs by 42 percent. An estimated 5,843 potential ADEs were avoided.

The initiative was led through the Child Health Corporation of America, a national business alliance of 42 of the nation's children's hospitals designed to focus on patient safety and improvement.

“We targeted areas with the most opportunity for improvement, and we worked together as a team to discuss barriers and strategies for change,” said Stacey Morgan Schlafly, quality improvement analyst at Children’s Hospital. “We were comfortable with the 50 percent goal and actually exceeded it.”

Children are three times more likely than adults to suffer an adverse drug event.

“They are a more vulnerable population,” said Amy Potts, assistant director of Pharmacy Services at Children’s Hospital. “Pediatric patients have variable pharmacokinetics and pharmacodynamics making it more difficult to predict adverse drug events. Infants also have less of a buffer to compensate if an error does occur. As an example, if an adult inadvertently receives a tenfold overdose of a drug, the patient may suffer minimal harm or no harm at all. But for a 400 gram critically ill neonate, the same error could be fatal.”

Potts also noted that medicines for children are complicated by the age-based and weight-based dosing, and there are also a lot of medications that aren’t available in a ready-to-administer form suitable for pediatric patients requiring further manipulation prior to administration whether it be from a tablet form into an oral liquid or dilution of a more concentrated product more accommodating to adult patients.

Schlafly and Potts worked with a multidisciplinary team – physicians, nurses, pharmacists, educators, information technology specialists, among others – to review protocols and processes for ordering, dispensing and administering medications.

In order to sustain the winning metrics achieved through this collaborative, the group was formalized, under the direction of Paul Hain, M.D., and Jenny Slayton of Performance Management and Improvement, and dubbed the Medication Use Safety Improvement Committee (MUSIC).

In-house, Children’s Hospital focused on three types of high-risk medications: anticoagulants, narcotics and total parenteral nutrition (TPN).

Among the strategies, the team worked to ensure medication double-checks, in which a second person does an independent check to ensure the right drug is the right dose for the right patient.

Also, the concept of “In the Zone” was introduced by a NICU nurse practitioner, Wendy Bateman. This developed into a culture change, in which the phrase “I’m in the zone” is used so people know not to disrupt a person during the medication use process.

“We need to continue these discussions in order to sustain the progress we have made,” said Schlafly, continuing, “but it’s very exciting that Children’s Hospital is on the cutting edge for setting benchmarks in medication safety.”