Ambulatory Pediatric Safety Learning Lab

流动儿科安全学习实验室

• 批准号: 10268169
• 负责人: Eric Steven Kirkendall
• 金额: $ 44.41万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268169
• 关键词: Ambulatory; Pediatric; Safety; Learning; Lab

ABSTRACT After almost two decades of research and quality improvement, hospitalized children in the US are safer from healthcare-related harm. The vast-majority of healthcare, however, is provided in the clinic and at home, and few studies in this context have demonstrated how to improve safety. Children are especially vulnerable to preventable harm caused by healthcare for many reasons, including weight-based medication dosing, handoffs between caregivers, and their limited ability to communicate evolving symptoms. At home, two in five children with chronic disease have a medication error. Of these, 3.6% are injured due to these errors—the same rate as hospitalized children. Among the 165,000 children with type 1 diabetes (T1D) nationally, 20% have poor glycemic control. The leading cause of death before age 30 among individuals with T1D is acute complications (e.g., severe hypoglycemia, diabetic ketoacidosis). One in 68 children have autism spectrum disorder (ASD). Of these children, 40% take antipsychotic medications, and most are not screened for complications. Management of chronic conditions with families is complex and offers a myriad of opportunities for system failures to occur that can lead to patient harm. We have identified 3 key opportunities to reduce the 2 most egregious harms in this setting—medication errors and treatment delays—in 2 different conditions. The Ambulatory Pediatric Patient Safety Learning Lab aims to: 1. Redesign processes for adjustment of medication dosing based on clinical information gathered by the patient/family to prevent medication errors. (This will be studied in type 1 diabetes) 2. Create processes for patient/family medication monitoring and communication with clinic to prevent adverse drug events. (This will be studied in children with Autism spectrum disorder on antipsychotics) 3. Design a workflow to plan for, detect and prompt management of serious illness among children with chronic conditions at home (This will be studied in both populations) This learning lab integrates design and systems engineering—in collaboration with Mad*Pow, and University of Wisconsin Systems Engineering Initiative for Patient Safety—with Cincinnati Children’s expertise in patient- centered research and implementation. The overarching goal is to redesign systems of care and coordination between the clinic and home to eliminate harm due to healthcare in these settings. Problem analysis will include ethnography in the home and clinic, interviews, FMEAs, and digital diaries. We will implement all interventions together in the simulated environment and evaluate using a randomized factorial trial. Finally, we will implement in our clinical system with qualitative and quantitative evaluation. The intent is to develop a scalable model which leverages health systems and patient/family strengths to ensure safe healthcare among all children. Upon completion of this proposal, our team is perfectly poised to scale this nationally through the Solutions for Patient Safety (SPS) Network and improve pediatric ambulatory safety across the US.

抽象的 经过近二十年的研究和质量改进，美国住院的儿童更加安全 与医疗保健相关的伤害。然而，绝大多数医疗保健是在诊所和家里提供的，并且 很少有这方面的研究表明如何提高安全性。儿童特别容易受到 医疗保健造成的可预防伤害有多种原因，包括基于体重的药物剂量、交接 护理人员之间的沟通，以及他们沟通不断变化的症状的能力有限。在家里，五分之二的孩子 患有慢性病有用药错误。其中，3.6% 的人因这些错误而受伤——与 住院的儿童。全国 165,000 名 1 型糖尿病 (T1D) 儿童中，20% 生活贫困 血糖控制。 1 型糖尿病患者 30 岁之前死亡的主要原因是急性并发症 （例如，严重低血糖、糖尿病酮症酸中毒）。每 68 名儿童中就有 1 名患有自闭症谱系障碍 (ASD)。 在这些儿童中，40% 服用抗精神病药物，并且大多数没有接受并发症筛查。 与家人一起管理慢性病非常复杂，并为系统性治疗提供了无数的机会 发生故障可能会导致患者受伤。我们确定了 3 个关键机会来减少 2 个最 在两种不同的情况下，这种情况会造成严重的危害——用药错误和治疗延误。 流动儿科患者安全学习实验室的目标是： 1. 根据收集的临床信息重新设计调整药物剂量的流程 患者/家属，以防止用药错误。 （这将在 1 型糖尿病中进行研究） 2. 创建患者/家属药物监测和与诊所沟通的流程，以预防 药物不良事件。 （这将在患有自闭症谱系障碍的儿童中使用抗精神病药物进行研究） 3. 设计一个工作流程来规划、检测和提示患有严重疾病的儿童的管理 家里的慢性病（这将在两个人群中进行研究） 该学习实验室与 Mad*Pow 和大学合作，整合了设计和系统工程 威斯康星州患者安全系统工程倡议——辛辛那提儿童医院在患者安全方面的专业知识 集中研究和实施。总体目标是重新设计护理和协调系统 诊所和家庭之间的联系，以消除这些环境中医疗保健造成的伤害。问题分析将 包括家庭和诊所的民族志、访谈、FMEA 和数字日记。我们将全部落实 在模拟环境中共同干预并使用随机析因试验进行评估。最后， 我们将在我们的临床系统中实施定性和定量评估。其目的是开发一个 可扩展的模型，利用卫生系统和患者/家庭的优势来确保安全的医疗保健 所有的孩子。完成此提案后，我们的团队完全准备好通过 患者安全解决方案 (SPS) 网络并改善全美儿科门诊安全。