Human and System Factors Contributing To Pediatric Medication Error and Injury

 描述(由申请人提供)：门诊用药错误可能是慢性病儿童的致命问题；过量服药可能是致命的，长期服药不足(不坚持)会导致严重伤害。四分之一的儿童患有慢性病，五分之一的儿童每天服用药物。虽然众所周知，患有慢性病的儿童只有一半的 他们的药物，由于错误导致的不依从量还没有在任何人群中进行研究。由于按体重给药的复杂性、多名照顾者之间的协调以及液体药物的使用，流动儿童特别容易受到可预防的不良药物事件的影响。迫切需要概括性的、严谨的 慢性病患儿用药差错及伤害的调查研究儿科癌症是了解慢性病护理的理想模式：用药不足和过量都会危及生命，所有形式的药物都是全国性的(静脉、药丸、液体)，我们的初步数据表明，因用药错误而造成伤害的发生率非常高(3.6%的儿童)。我们的长期目标是支持门诊儿童安全有效地使用药物。在这项提案中，在癌症儿童中，我们的目标是：1)对门诊用药错误的发生率和类型进行分类，包括照顾者错误和可预防的不良药物事件；2)确定错误对不遵守的影响；以及3)确定导致门诊用药错误的个人、家庭和医疗保健系统因素。我们的团队非常适合执行拟议的工作，结合了全国知名的门诊用药差错专家，包括护理者给药、依从性和人为因素。我们将对来自三个中心的300名白血病和淋巴瘤儿童进行纵向队列研究。家庭将参加三次家访。错误将使用我们开发和验证的四个组成部分的方法来衡量：医疗记录审查、药瓶审查、给药观察和照顾者面谈。不遵守将被测量的电子监测装置和自我报告。我们将使用环境扫描和照顾者完成的标准化在线问卷来确定导致错误的因素。拟议的工作将大大有助于我们了解差错的流行病学和因用药差错而造成的伤害类型的范围。此外，我们将确定有助于门诊安全的因素，包括提供者与家庭的互动、防护行为和工具，以及卫生系统在门诊安全中的作用。据我们所知，这将是关于坚持和错误关系的第一次研究。所获得的知识将立即使患者、家属和临床医生受益，然后他们可以采取措施将错误和相关伤害降至最低。研究人员可以在这一知识的基础上，将在住院环境中广泛使用的人的因素理论应用到儿童的门诊环境中。拟议的工作提供了开发和测试针对动态用药错误和相关伤害的新干预措施所需的关键信息。

 DESCRIPTION (provided by applicant): Ambulatory medication error can be a lethal problem in children with chronic conditions; overdoses can be fatal and chronic under-doses (non-adherence) lead to serious injury. One in four children has a chronic condition and one in five takes a daily medication. While it is known that children with chronic conditions take only half of their medications, the amount of non-adherence which is caused by error has not been studied in any population. Ambulatory children are particularly vulnerable to preventable adverse drug events, due to the complexity of medication weight-based dosing, coordination between multiple caregivers, and the use of liquid medications. There is a critical need for generalizable, rigorous study of medication error and injury in children with chronic conditions to inform intervention. Pediatric cancer is an ideal model condition to understand chronic disease care: medication under- and overdoses are life-threatening, all forms of medication are nationally (intravenous, pills, liquids), and our preliminary data indicates that the prevalence of injuries due to medicatin error is very high (3.6% children). Our long term objective is to support the safe and effective use of medications among ambulatory children. In this proposal, among children with cancer, we aim to: 1) categorize rates and types of ambulatory medication error, including caregiver error, and preventable adverse drug events; 2) identify the contribution of error to non-adherence; and 3) identify individual, family, and healthcare system factors that contribute to ambulatory medication error. Our team is ideally suited to perform the proposed work, combining nationally known experts in ambulatory medication errors, including caregiver administration, adherence, and human factors. We will conduct a longitudinal cohort study of 300 children with leukemia and lymphoma from three centers. Families will participate in three home visits. Errors will be measured using a four-component approach we developed and validated: medical record review, medication bottles review, observation of administration, and caregiver interview. Non-adherence will be measured electronic monitoring devices and self-report. We will identify factors that contribute to error using an environmental scan and standardized online questionnaires completed by caregivers. The proposed work will substantially contribute to our knowledge of the epidemiology of error and the range of types of injuries due to medication error. In addition, we will identify factors contributing to ambulatory safety, including provider-family interaction, protective behaviors and tools, and the role of the health system in ambulatory safety. This will be the first study, to our knowledge, of the relationship of adherence and error. Knowledge gained will immediately benefit patients, families, and clinicians who can then take steps to minimize errors and associated injury. Researchers may build on this knowledge to apply human factor theory, widely used in the inpatient setting, to the ambulatory setting in children. The proposed work provides the critical information needed to develop and test novel interventions targeting ambulatory medication error and associated injury.