A Systems Approach to Improve Safe Medication Management for Children with Medical Complexity

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PROJECT SUMMARY The proposed research addresses a key patient safety gap among children with medical complexity (CMC) transitioning between hospital and home—medication related harm. CMC are often on multiple and complex medication regimens and have intensive healthcare needs. As a result, they experience frequent transitions of care, across professional roles and care settings and during these transitions, CMC are at great risk for medication-related harm. Most transitional care interventions have been adopted from adult care settings and may not be adequate to address the unique needs of CMC and their family caregivers. Interventions that are grounded in the unique situations and complexities of such patients are needed to improve medication use safety and family experience of care. This proposal describes the PI’s plan to transition into an independent investigator by developing expertise in 1) participatory, human centered design to co-develop useful interventions, and 2) implementing and evaluating interventions. The proposal also describes a 4-year project for developing a prototype care transition medication safety intervention and generating early evidence on its usability and potential factors influencing its future implementation. Aim 1: Patient journey mapping—will be used to elucidate medication safety risks and contexts during the hospital-to-home transition period. Journey maps will be used to capture and visually represent the medication use experience of families across professional settings and boundaries. The output of this aim will inform prototype design under Aim 2. Aim 2: Participatory, human centered design to co-design a prototype medication safety intervention. Through multiple, iterative co-design sessions involving healthcare workers and family caregivers, a team will design a prototype medication safety intervention informed by journey maps from Aim 1, current literature, and participant elicitations. The result will be a composite prototype ready for usability testing. Aim 3: Will test usability of prototype intervention with healthcare workers and family caregivers. Additionally, barriers and facilitators that may be anticipated during future prototype implementation will be explored. Taken together, all 3 aims will yield a final, refined prototype intervention designed to improve medication use safety during care transitions. Future work will include a randomized controlled trial of the prototype medication safety intervention to formally evaluate it effectiveness in preventing or reducing medication related harm as well as improving the medication use experience of CMC and their family caregivers.