A current safety concern in your practice environment.

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Current Safety Concern and HIT Application in a Pediatric Emergency Department

A significant current safety concern in my pediatric emergency department (PED) is the risk of medication errors, particularly during the high-pressure and fast-paced environment of acute care. The potential for wrong dose calculations based on weight, incorrect medication selection from automated dispensing cabinets, and miscommunication during verbal orders poses a constant threat to patient safety in this vulnerable pediatric population. Children require precise weight-based dosing, and the variety of available drug concentrations and formulations increases the complexity of medication administration, making them particularly susceptible to errors (Alsulami et al., 2020).  

One Health Information Technology (HIT) that could be applied to address this concern is the implementation of a fully integrated Closed-Loop Medication Administration (CLMA) system with barcode medication administration (BCMA). This system integrates electronic prescribing (e-prescribing), pharmacy dispensing, and bedside medication verification through barcode scanning.

Full Answer Section

        The CLMA/BCMA system could be applied to enhance safety at multiple points in the medication administration process: Electronic Prescribing (e-Prescribing) with Integrated Decision Support: When a provider enters a medication order, the e-prescribing system, integrated with the patient's weight and age, can automatically calculate the correct dose range and flag any orders outside of established safety parameters. It can also provide alerts for potential drug-drug interactions, allergies, and contraindications specific to the pediatric population. This reduces the risk of prescribing errors related to incorrect dosing or inappropriate medication selection. Pharmacy Verification with Barcode Labeling: Once the order is verified by the pharmacy, the medication is dispensed with a unique barcode that contains information such as the drug name, strength, formulation, lot number, and expiration date. This ensures the correct medication is dispensed by the pharmacy. Bedside Medication Verification (BCMA): At the bedside, before administering the medication, the nurse would scan the patient's wristband barcode and the barcode on the medication. The CLMA system would then verify that the right patient is receiving the right drug, in the right dose, via the right route, and at the right time. Any mismatch between the scanned information and the electronic medication administration record (eMAR) would trigger an alert, preventing potential administration errors. This real-time verification significantly reduces the risk of administering the wrong medication or dose. One possible unintended consequence of adopting a fully integrated CLMA/BCMA system is alert fatigue. If the system generates excessive or non-critical alerts, clinicians may become desensitized to them and potentially override important warnings, negating the safety benefits of the technology (Khajouei et al., 2016). For example, frequent alerts about minor potential drug interactions that are clinically insignificant in the specific patient context could lead to clinicians ignoring all alerts, including those indicating a serious error. At least one strategy for mitigating the unintended consequence of alert fatigue is robust alert management and customization. This involves: Evidence-Based Alert Configuration: Implementing only clinically relevant and high-priority alerts based on current best practices and pediatric-specific guidelines. Alert Prioritization and Filtering: Categorizing alerts based on severity and allowing clinicians to filter or customize the types of alerts they receive based on their role and the patient's condition. Clinical Decision Support Optimization: Regularly reviewing and refining the clinical decision support rules within the CLMA system to ensure accuracy, specificity, and minimize false positives. This requires ongoing collaboration between IT specialists, pharmacists, and pediatric emergency medicine physicians and nurses. User Training and Feedback Mechanisms: Providing comprehensive training to all users on the appropriate interpretation and management of alerts. Establishing clear channels for clinicians to provide feedback on the relevance and utility of alerts, allowing for continuous system improvement. By thoughtfully implementing and managing a CLMA/BCMA system with a focus on minimizing alert fatigue, a pediatric emergency department can significantly enhance medication safety and reduce the risk of potentially harmful medication errors in this vulnerable patient population. Reference: Alsulami, W. T., Manias, E., & Bajorek, B. V. (2020). The prevalence and nature of medication errors in hospitalised paediatric patients: a systematic review. Journal of Clinical Pharmacy and Therapeutics, 45(1), 15-25. https://doi.org/10.1111/jcpt.13031 Khajouei, J., Jaspers, M. W. M., de Keizer, N. F., & Sheikhbahaei, S. (2016). The impact of medication alerts on physicians’ prescribing behavior: a systematic review. Methods of Information in Medicine, 55(1), 82-91. https://doi.org/10.3414/ME14171 Sources and related content