A Systems Engineering Approach to Optimize Pediatric Medication Safety

摘要 这项拟议的研究的目的是提高电子健康记录中的儿科用药安全性 (EHR)通过优化、部署和测试旨在识别儿童体重的评估工具- 基于剂量错误。自我评估工具设计为供任何医疗保健提供者组织使用， 不考虑可用性、专业知识或信息学资源。在目标1中，我们将优化现有的儿科 通过与儿科、用药领域的主题专家接触，为EHR提供用药安全性评估工具 安全、工具开发和信息学；该工具是由宾夕法尼亚州患者资助开发的 安全管理局。我们将使用REACH有效性采用的循证实施框架 部署和测试工具的实施维护(RE-AIM)。在Aim 2中，我们将部署该工具用于在 将有目的地选择至少20个不同的医疗保健提供者组织，以确保多样性 在地理位置、患者数量和电子病历供应商方面。在目标3中，我们将比较儿科用药 能够在EHR中进行更改以解决上标记为有缺陷的项目的站点之间的错误 评估工具与那些无法进行更改的工具。 这项研究是MedStar Health的国家人类因素中心在 亚特兰大/埃默里大学医疗保健和儿童保健。这个项目利用了集体的专业知识 不同的研究团队，包括人因工程、儿科用药安全、健康 信息技术、可用性和患者安全。研究团队具有丰富的开发经验。 评估工具，传播这些工具以供广泛使用，并确定重要的技术领域 和安全改进。 在这个项目结束时，我们将开发一个带有测试用例的工具来评估EHR的安全性 儿科基于体重的给药错误。此外，我们还将确定工具使用的障碍和促进者 具有不同资源可用性级别的设置。最后，我们将就如何 自定义该工具以支持跨具有不同资源级别的不同医疗保健设置进行评估 可用于提高患者的安全和质量。

ABSTRACT The objective of the proposed research is to improve pediatric medication safety in the electronic health record (EHR) through optimization, deployment, and testing of an assessment tool designed to identify pediatric weight- based dosing errors. The self-evaluation tool is designed for use by any healthcare provider organization, regardless of usability expertise or informatics resources. In Aim 1, we will optimize an existing pediatric medication safety evaluation tool for the EHR by engaging with subject matter experts in pediatrics, medication safety, tool development, and informatics; this tool was developed through funding from the Pennsylvania Patient Safety Authority. We will use the evidence-based implementation framework of Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) to deploy and test the tool. In Aim 2, we will deploy the tool for testing in at least twenty different healthcare provider organizations that will be purposefully selected to ensure diversity in geographical location, patient population, and EHR vendor. In Aim 3, we will compare pediatric medication errors between sites that are able to make changes in the EHR to address items flagged as deficient on the assessment tool vs. those that are unable to make the changes. The research effort is a unique collaboration between MedStar Health's National Center for Human Factors in Healthcare and Children's Healthcare of Atlanta/Emory University. This project utilizes the collective expertise of the diverse research team which includes human factors engineering, pediatric medication safety, health information technology, usability, and patient safety. The research team has extensive experience developing assessment tools, disseminating these tools for widespread use, and identifying important areas for technology and safety improvement. At the end of this project, we will have developed a tool with accompanying test cases to assess EHR safety for pediatric weight-based dosing errors. In addition, we will also identify barriers and facilitators to tool use across settings with varying levels of resource availability. Finally, we will develop recommendations on how to customize the tool to enable assessment across diverse healthcare settings that have varying levels of resources available for improving patient safety and quality.