Assessment of Pediatric Look-alike, Sound-alike (LASA) Substitution Errors

儿科外观相似、声音相似 (LASA) 替换错误的评估

• 批准号: 8044839
• 负责人: WILLIAM T BASCO
• 金额: $ 5万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8044839
• 关键词: Assessment; Pediatric; Look; alike; Sound

DESCRIPTION (provided by applicant): This application is responsive to Program Announcement PAR-08-268, the AHRQ Small Research Grant to Improve Health Care Quality through Health Information Technology (HIT). This application addresses the "Research Area" of "Medication Management" evaluating errors at the point of delivering ambulatory prescriptions. This application meets the "Specific Purpose" of the FOA by "generating information necessary for future health IT implementation projects." Our research design includes one of the suggested approaches for research responsive to this FOA - "self-contained HIT research projects." The PI is has new-investigator status, in his final year of an AHRQ-sponsored career development award. The objective of this R03 study is to expand upon preliminary work that evaluated frequencies of Look-alike, Sound-alike (LASA) errors among 11 selected pairs of pediatric medications. It is necessary to identify a larger set of candidate LASA drug pairs for intervention and refine the method for "flagging" individual prescriptions as potential LASA errors. The proposed study will utilize both qualitative and quantitative methods in completing study aims. We will evaluate a list of >1500 LASA drug pairs, using a modified Delphi method to reduce this list of LASA drug pairs to a list of approximately 200 drug pairs felt to be problematic in ambulatory pediatric care. We will then estimate rates of LASA errors utilizing an algorithm developed previously. There are 2 aims to this study. Aim 1: Identify a subset pediatric-specific, problematic LASA drug pairs. Using a modified Delphi approach, we will reduce the list of 1500 known LASA pairs to a targeted list of approximately 200 LASA drug pairs that are used in ambulatory pediatric practice and felt to be of high risk of harm to a child should a substitution occur. Aim 2a: Estimate frequencies of potential LASA substitution errors in these drug pairs, using South Carolina Medicaid data from 2000-2008. These calculations will build upon pilot efforts evaluating a list of 11 drug pairs using a similar method, completed as part of the PI's career development award. Aim 2b: Determine the positive predictive value ("true error rate") of the screening alerts identified for Aim 2a. We expect that this course of inquiry will ultimately lead to a computerized set of pediatric-specific LASA screening alerts that could be implemented in the pharmacy setting to reduce LASA errors for children. This analytic approach will also have future applicability to inpatient pediatric medication safety, as a similar approach could identify a list of pediatric-specific inpatient drugs to incorporate into CPOE systems. This study will ultimately improve pediatric prescribing safety by developing an expanded panel of LASA drug pairs commonly used in pediatric ambulatory care and considered at high risk to patients should a substitution occur. Such a targeted, pediatric list does not currently exist. Work completed as part of this R03 application will lay the groundwork for development of a larger-scale implementation study in pharmacy settings, with the goal of reducing pediatric ambulatory LASA errors. PUBLIC HEALTH RELEVANCE: Project Narrative - Prevention of medication errors is a priority in US healthcare, and Health Information Technology (HIT) offers substantial promise to reduce those errors. This study will identify a candidate list of LASA drug pairs commonly used in pediatric care and will estimate frequencies of LASA errors in those drug pairs using approximately 18 million ambulatory prescriptions. The findings of this study will be used to further develop a real-time, pharmacy based screening program to identify potential LASA errors at the point of prescription delivery, thereby meeting the goals of the program announcement "to improve the quality, safety, effectiveness, and efficiency of health care through the implementation and use of health IT."

描述（由申请人提供）：此申请对计划公告PAR-08-268，AHRQ小型研究赠款响应，以通过健康信息技术（HIT）提高医疗保健质量。该申请介绍了“药物管理”的“研究领域”，该申请在提供门诊处方时评估错误。该应用程序通过“生成未来健康IT实施项目所需的信息”来符合FOA的“特定目的”。我们的研究设计包括响应这种FOA的建议的研究之一 - “独立的HIT研究项目”。 PI在AHRQ赞助的职业发展奖的最后一年中具有新的投票员身份。这项R03研究的目的是扩大初步工作，该工作评估了11种儿科药物成对的外观，类似（LASA）错误的频率。有必要确定一组较大的候选LASA药物对进行干预，并完善“标记”单个处方作为潜在LASA错误的方法。拟议的研究将利用定性和定量方法来完成研究目标。我们将使用改良的Delphi方法评估> 1500个LASA药物对的列表，以将这一LASA药物对列表减少到大约200个药物对的列表中，这在卧床儿科护理中是有问题的。然后，我们将利用先前开发的算法估算LASA错误的速率。这项研究有2个目标。 AIM 1：确定子集小儿特异性的有问题的LASA药物对。使用修改后的Delphi方法，我们将将1500个已知LASA对的列表减少到一个大约200个LASA药物对的目标列表中，这些清单在卧床儿科实践中使用，并认为如果发生替代，则会对儿童造成高伤害。 AIM 2A：使用2000 - 2008年的南卡罗来纳州医疗补助数据，在这些药物对中潜在LASA替代错误的频率。这些计算将以试点努力为基础，以使用类似方法评估11对毒品对的列表，并作为PI职业发展奖的一部分完成。 AIM 2B：确定为AIM 2A确定的筛选警报的正预测值（“真实错误率”）。我们预计，这种询问过程最终将导致一组计算机化的小儿特异性LASA筛查警报，这些警报可以在药房环境中实施，以减少儿童的LASA错误。这种分析方法还将对住院儿科用药安全具有未来的适用性，因为类似的方法可以识别出儿科特异性的住院药物清单，以纳入CPOE系统。这项研究最终将通过开发一组扩展的LASA药物对面板来改善小儿处方安全性，并在小儿门诊护理中使用，并考虑替代的情况下对患者的高风险。当前不存在这样的有针对性的儿科清单。作为此R03申请的一部分完成的工作将为在药房环境中开发大规模实施研究的开发奠定基础，目的是减少儿科门诊洛杉矶洛杉矶的错误。 公共卫生相关性：项目叙事 - 预防药物错误是美国医疗保健的优先事项，健康信息技术（HIT）提供了减少这些错误的实质性希望。这项研究将确定在小儿护理中常用的LASA药物对的候选清单，并将使用约1800万个非卧床处方估计这些药物对中lasa错误的频率。这项研究的发现将用于进一步制定实时的基于药房的筛查计划，以确定处方交付时的潜在LASA错误，从而实现了计划公告的目标，“通过实施和使用健康IT来提高质量，安全性，安全性，安全性，有效性和效率”。