Improving medication safety for medically complex children with mHealth across caregiving networks

项目摘要 具有医学复杂性（CMC）的儿童特别容易发生用药错误和药物不良事件 因为他们极端的多种药物，潜在的医疗脆弱性，以及对复杂药物的依赖 时间表和路线。CMC发生导致紧急情况的药物不良事件的可能性高出5倍 部门（艾德）访问比其他儿童。超过1/50次CMC艾德访视是由于药物不良事件， 38%的CMC艾德访视药物不良事件导致住院。有准确的知识， 准确给予高危药物是安全用药管理的绝对要求。先前工作 观察到给药准确性，即，了解适应症、剂型、剂量、频率，以及 不到一半的CMC护理人员成功描述了给药途径。低剂量用药 给药准确性导致不良药物事件，包括潜在可预防的住院治疗， 急诊和发病率。目前，没有工具可以支持CMC家族，以确保高 参与CMC日常护理的“二级”护理人员网络中的药物给药准确性 (e.g.,家庭、家庭护理专业人员、学校护理人员等）。为了解决这些关键的未满足的需求，我们 将创建一个移动的健康（mhealth）平台，MedS@HOME（MedS@HOME），以改善CMC 通过支持整个医疗网络的标准化药物管理来确保药物安全。我们 预计MedS@HOME将提高药物管理的准确性，并减少药物相关的 不良事件，并最终改善慢性病护理管理，通过创建和促进 整个医疗网络的标准化药物管理实践。为了实现这一目标，我们 建议实现以下目标：1）通过参与式共同设计MedS@HOME干预措施， 与三个设计团队在并行设计过程中与利益相关者一起进行设计：一个是主要CMC 护理人员，一个与二级护理人员，一个与药物安全和CMC临床护理专家; 2） 评价MedS@HOME对高危药物给药准确性的有效性 (e.g.,抗癫痫药物，阿片类药物）在一项随机对照试验中，测试的假设， 通过使用MedS@HOME，提高了主要和次要护理人员的给药准确性。 目标的完成将导致可扩展的mhealth干预，提高CMC的用药安全性 在整个网络上。MedS@HOME，完善后，可以改善用药安全性和慢性 在依赖医疗网络的广泛人群中进行护理管理。

PROJECT SUMMARY Children with medical complexity (CMC) are uniquely vulnerable to medication errors and adverse drug events because of their extreme polypharmacy, underlying medical fragility, and reliance on complicated medication schedules and routes. CMC have 5 times higher odds of an adverse drug event leading to an Emergency Department (ED) visit than other children. Over 1 of 50 CMC ED visits are due to adverse drug events, and 38% of CMC ED visits for adverse drug events result in hospital admission. Having accurate knowledge to accurately give high-risk medications is an absolute requirement for safe medication management. Prior work observed that medication administration accuracy, i.e., knowing indication, formulation, dose, frequency, and route of administration, was successfully described by fewer than half of CMC caregivers. Low medication administration accuracy leads to adverse drug events, including potentially preventable hospitalizations, emergency department visits, and morbidity. Currently, no tools exist to support families of CMC to ensure high medication administration accuracy across their network of “secondary” caregivers involved in CMC daily care (e.g., family, in-home care professionals, school caregivers, etc.). To address these critical unmet needs, we will create a mobile health (mhealth) platform, Medication Safety @HOME (MedS@HOME) to improve CMC medication safety by supporting standardized medication management across the caregiving network. We anticipate that MedS@HOME will increase medication administration accuracy and reduce medication-related adverse events, and ultimately improve chronic care management through the creation and promotion of standardized medication management practices across the caregiving network. To achieve this goal, we propose to conduct the following aims: 1) Design the MedS@HOME intervention through participatory co- design with stakeholders in a parallel design process with three design teams: one with primary CMC caregivers, one with secondary caregivers, and one with experts in medication safety and CMC clinical care; 2) Evaluate the effectiveness of MedS@HOME on medication administration accuracy of high-risk medications (e.g., antiepileptic drugs, opioids) in a randomized controlled trial, testing the hypothesis that medication administration accuracy is improved for primary and secondary caregivers with use of MedS@HOME. Completion of the aims will result in a scalable mhealth intervention that improves medication safety for CMC across the caregiving network. MedS@HOME, when perfected, can improve medication safety and chronic care management across the wide range of populations that depend on caregiving networks.