Pediatric Adverse Event Risk Reduction for High Risk Medications in Children and Adolescents: Improving Pediatric Patient Safety in Dental Practices

一个狭窄的安全边际存在于儿童牙科病人的护理，这往往发生在实践中设置 患者的完整病史信息较少，而这对牙科的安全实践至关重要。虽然 牙医在日常实践中管理和开处方数量有限的药物， 存在人为错误和并发症的高风险。高风险药物经常被处方， 由牙医给儿童使用，并导致严重的意外后果，包括不良反应。 在清醒镇静或全身麻醉期间发生的事件-如死亡，以及阿片类药物的过量处方。 在美国，每年有超过100，000例儿童牙科镇静。 用于这些程序的是苯二氮卓类、阿片类和全身麻醉剂。所有这些都与严重 不良事件，包括低氧血症、呼吸抑制、气道阻塞和死亡。大多数美国人 第一次接触阿片类药物是在他们年轻的时候，在第三磨牙拔除之后。使用处方阿片类药物 与成人滥用阿片类药物的风险增加有关。这些在成年早期的趋势， 牙科镇静程序后发生的儿科死亡病例报告明确了 了解并实施儿童牙科护理中的最佳患者安全实践。然而，美国的数据显示， 儿科牙医的药物处方模式，循证处方和社区牙科 提供者对儿科病人安全实施的态度是稀缺的。虽然努力和资源 存在减少阿片类药物的过度处方和儿科镇静的最佳患者安全实践，大多数 干预集中在医生和高级实践提供者（即，执业护士和医师 助理），并可能无法在更广泛的实施，以儿科牙科实践。这种混合的目的- 方法研究是通过识别目前的儿童高风险处方模式， 与不良健康结果相关的处方模式可以作为干预的目标。到 为了实现这一目标，我们的目标是：（1）确定高风险药物的处方程度 儿童牙科患者和不良患者结局的发生率， 和公共保险的儿童;（2）[检查]牙医对药物安全的态度时，处方高- 为儿科患者开具高风险药物时的风险药物和决策;以及（3） [制定并试行一份清单，以促进最能促进儿科用药安全的治疗决策。 牙科护理]。我们预计这项研究将缩小高风险牙科处方模式的知识差距， 儿童用药，与不良患者结局的相关性，并确定牙医对安全性的看法 这些药物。[This混合方法研究将设计并实施循证干预， 尽量减少高风险药物的危害，并改善儿童和青少年的安全牙科实践。

A narrow margin of safety exists in the care of pediatric dental patients, and this often occurs in practice settings with less information on patients’ full medical history that is crucial for the safe practice of dentistry. Although dentists administer and prescribe a limited number of medications in routine practice, many of these medications carry a high risk for human error and complications. High-risk medications are frequently prescribed and administered by dentists to children and have resulted in serious unintended consequences, including adverse events – such as death – during conscious sedation or general anesthesia, and the overprescribing of opioids. More than 100,000 pediatric dental sedations are performed annually in the U.S. The most common medications used for these procedures are benzodiazepines, opioids, and general anesthetics. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction and death. Most Americans have their first exposure to opioids in their youth following third molar extraction. This use of prescription opioids has been associated with an increased risk of opioid misuse into adulthood. These trends in early adulthood and case reports of pediatric deaths occurring following dental sedation procedures make clear the urgency to understand and implement best patient safety practices in the dental care of children. Yet, U.S. data on medication prescribing patterns of pediatric dentists, evidence-based prescribing and community dental providers’ attitudes toward implementation of pediatric patient safety is scarce. Although efforts and resources exist to curtail overprescribing of opioids and best patient safety practices in pediatric sedation, most interventions are focused on physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) and may fail in broader implementation to pediatric dental practices. The objective of this mixed- methods study is to improve high-risk pediatric prescribing patterns among dentists by identifying current prescribing patterns associated with poor health outcomes that could be targeted for intervention. To accomplish this objective we aim to: (1) determine the extent to which high-risk medications are prescribed to pediatric dental patients and rates of poor patient outcomes in a population-based sample of commercially- and publicly-insured children; (2) [Examine] dentists’ attitudes towards medication safety when prescribing high- risk medications and decision-making when prescribing high-risk medications for pediatric patients; and (3) [Develop and pilot a checklist to facilitate treatment decisions that best promotion medication safety in pediatric dental care]. We anticipate this study will close the knowledge gap on dental prescribing patterns of high-risk medications to children, association with poor patient outcomes, and determine dentist perceptions of the safety of these medications. [This mixed-methods study will design and implement an evidence-based intervention to minimize harms from high-risk medications and improve safe dental practice to children and adolescents.]