The SafeCare@Home4Kids Learning Lab: Designing Safer Healthcare at Home for Children

项目总结/摘要 患有医学复杂性的儿童是医学上脆弱的残疾患者中不断增长的人群。 患有医疗复杂性的儿童经历了约70%的计划外再入院， 与其他儿童相比，死亡率更高。这些孩子的日常生存需要父母和家庭 护士通过植入装置安全地管理复杂的药物治疗方案，例如插入导管 到胃里。虽然我们知道药物错误或器械相关不良事件正在发生， 在国内，没有家庭保健报告或反应标准来处理和预防这些问题。 自愿报告不能公平地反映少数群体背景儿童的事件， 处理预防问题。父母表示担心失去孩子的护理或孩子的监护权，如果他们提出 安全问题，特别是那些少数民族背景的人。虽然家庭是一个重要的医疗保健网站， CMC，没有科学的方法来确保医疗安全事件不会发生在家里。有一个 识别、沟通和预防家庭中发生的安全错误和不良事件的关键需求， 不同的父母和家庭医疗保健提供者的方式，将确保儿童没事，通知 儿童护理提供者，防止复发，并对所有患者和家庭公平。 我们的具体目标是：1）建立SafeCare@Home4Kids多学科专家实验室， 包括患者安全、人因工程、护理、儿科、HHC、信息学和生活家庭 经验，共同设计创新，有效和公平的方法，以防止医疗保健 不同CMC在家中经历的安全错误和不良事件; 2）确定家庭护理人员如何 目前，家庭护士可以识别、沟通和预防与药物和器械相关的错误 和不良事件的背景下，家庭工作系统;和3）共同设计，实施，并评估一个 安全工具包，利用家庭、家庭和医疗机构的意见， 护士，处方提供者和我们的实验室专家，以改善患者在家中的安全。 我们的儿科PSLL将是一个创新的范式转变，在安全性研究的重点是家庭作为一个 CMC的基本医疗实践环境。这项工作意义重大，因为SafeCare@Home4Kids 服务于AHRQ的交叉优先人群，这些人群可能无法获得授权或支持， 解决其医疗保健的安全性，并解决患有医学复杂性的儿童的常见原因 使用急诊室或住院。通过使用人因工程方法， 国家跨学科专家，与病人的家庭领导人合作，并招募一个语言和 种族多样化的参与者人口，我们将通过公平地影响 无论孩子在哪里都能得到安全的照顾。

PROJECT SUMMARY/ABSTRACT Children with medical complexity are a growing population of medically fragile patients with disability. Children with medical complexity experience ~70% of unplanned hospital readmissions and have a 10x higher odds of mortality compared to other children. These children’s daily survival requires parents and home nurses to safely administer intricate medication regimens through implanted devices, such as a tube inserted into the stomach. While we know that medication errors or device-related adverse events are happening at home, no home healthcare reporting or response standards exist to address and prevent them. Voluntary reporting does not equitably capture events in children of minority backgrounds or necessarily address prevention. Parents express fear of losing their child’s nursing care or their child’s custody if they raise safety concerns, especially those of racial minority backgrounds. While home is an essential healthcare site for CMC, no scientific approaches exist to make sure healthcare safety events do not happen at home. There is a critical need to identify, communicate, and prevent safety errors and adverse events that occur in the home by diverse parents and home healthcare providers in a manner that will make sure the children are okay, notifies the children’s care providers, prevents recurrence, and is equitable to all patients and families. Our specific aims are to 1) construct the SafeCare@Home4Kids multidisciplinary lab of experts, including in patient safety, human factors engineering, nursing, pediatrics, HHC, informatics, and lived family experience to work together to design innovative, effective, and equitable approaches to prevent healthcare safety errors and adverse events experienced by diverse CMC at home; 2) determine how family caregivers and home nurses currently identify, communicate, and prevent medication and device-related errors and adverse events in the context of the home work system; and 3) co-design, implement, and evaluate a safety toolkit that addresses these elements of medication and device safety using input from families, home nurses, prescribing providers, and our lab experts, to improve patient safety at home. Our pediatric PSLL will be an innovative paradigm shift in safety research by focusing on the home as a fundamental healthcare practice setting for CMC. This work is significant because SafeCare@Home4Kids serves intersecting AHRQ priority populations who may not otherwise be empowered or supported to address the safety of their healthcare and addresses common reasons children with medical complexity use the emergency department or are hospitalized. By using a human factors engineering approach with national interdisciplinary experts, partnering with patient family leaders, and recruiting a linguistically and racially diverse participant population, we will advance whole-person 360-degree by equitably impacting the safety of care no matter where a child calls home.