Effectiveness of Pictographs to Prevent Wrong-Patient Errors in the NICU

错诊误诊严重威胁患者安全，新生儿重症监护 重症监护病房(NICU)的风险最大。据估计，NICU中任何一天都有一半的婴儿有患上 由于具有相似的标识符而导致的患者错误。一个主要的贡献因素是使用 临时的、不明确的名字，例如，BabyBoy/BabyGirl，出生时分配给新生儿并一直保留下来 在他们住院期间没有变化。使用独特的新生儿命名约定，该约定结合了 母亲的名字(例如，WendysGirl)将NICU中误开病人医嘱的风险降低了36%。然而， 独特的命名惯例只对独生子女有利--多胎生育仍然是一种高风险 由单个字符区分的同名兄弟姐妹的结果(例如，1WendysGirl，2WendysGirl)。 在电子健康记录(EHR)中显示患者照片是一种很有前途的改进策略 病人身份证明。然而，在NICU中，照片不太可能成为有效的标识，因为 迫切需要额外的识别符。代替病人照片，我们建议使用BabySafe象形文字 作为新生儿在NICU的“照相工具”。象形文字由三个要素组成：1)象形文字 易辨认的、独特的、易记的物体；2)婴儿的名字；3)颜色-- 编码边框指示婴儿的性别。床边和电子病历内将展示象形图，以提供服务 作为供应商下单时的视觉提示。父母将为他们的婴儿选择一个象形文字 他们住在医院，没有两个婴儿在同一个NICU的同一时间有相同的象形文字。 我们建议进行一项整群随机对照试验来评估象形文字的有效性 以减少NICU中错误的病人订单。我们将使用自动错误患者退回和重新排序 由本提案的主要调查员制定和验证的措施，作为主要成果 测量。我们的主要假设是，象形文字将减少错误的患者订单的频率 NICU，包括多胎兄弟姐妹。我们提出了以下具体目标： 目的1：进行多点、整群随机对照试验，比较错误率和误诊率。 NICU提供者之间的患者订单随机分为有无验证屏幕和无验证屏幕 BabySafe象形文字，由错误的患者收回和重新排序测量确定。 目的2：对BabySafe象形文字减少儿童死亡率的有效性进行亚组分析 新生儿重症监护室多胎兄弟姐妹错医嘱的发生频率。 目标3：进行定性评估，以检查对医疗保健的看法和体验 供应商和父母将BabySafe象形文字作为新生儿在NICU的额外标识。 这项提案解决了国家儿童健康与人类研究所确定的研究空白 开发，寻求开发新的和改进的新生儿患者识别方法的项目。

Wrong-patient errors pose a serious threat to patient safety, and newborns in the neonatal intensive care unit (NICU) are at greatest risk. Half of infants in the NICU on any given day are estimated to be at risk of a wrong-patient error as a result of having similar identifiers. A major contributing factor is the use of temporary, nondistinct first names, e.g., Babyboy/Babygirl, that are assigned to newborns at birth and remain unchanged throughout their hospital stay. Use of a distinct newborn naming convention that incorporated the mother’s first name (e.g., Wendysgirl) reduced the risk of wrong-patient orders in the NICU by 36%. However, the distinct naming convention conferred benefit only for singletons—multiple births remained at high risk as a result of siblings sharing the same name distinguished by a single character (e.g., 1Wendysgirl, 2Wendysgirl). Displaying patient photographs in electronic health records (EHRs) is a promising strategy to improve patient identification. However, photographs are unlikely to be an effective identifier in the NICU where an additional identifier is urgently needed. In place of patient photographs, we propose BabySAFE Pictographs as a “photo equivalent” for newborns in the NICU. Pictographs consist of three elements: 1) a pictorial image of a readily identifiable, distinctive, and easy-to-remember object; 2) the infant’s given name; and 3) a color- coded border indicating the infant’s sex. Pictographs will be displayed at the bedside and in the EHR to serve as a visual cue when providers place orders. Parents will select a Pictograph for their infants for the duration of their hospital stay, with no two infants having the same Pictograph at the same time in the same NICU. We propose conducting a cluster randomized controlled trial to assess the effectiveness of Pictographs for reducing wrong-patient orders in the NICU. We will use the automated Wrong-Patient Retract-and-Reorder measure, developed and validated by the Principal Investigator of this proposal, as the primary outcome measure. Our main hypothesis is that Pictographs will reduce the frequency of wrong-patient orders in the NICU, including among siblings of multiple births. We propose the following specific aims: Aim 1: To conduct a multi-site, cluster randomized controlled trial to compare the frequency of wrong- patient orders in the NICU between providers randomized to view verification screens with versus without BabySAFE Pictographs, as identified by the Wrong-Patient Retract-and-Reorder measure. Aim 2: To conduct subgroup analyses of the effectiveness of BabySAFE Pictographs for reducing the frequency of wrong-patient orders among siblings of multiple births in the NICU. Aim 3: To conduct a qualitative evaluation to examine the perceptions and experiences of healthcare providers and parents about BabySAFE Pictographs as an additional identifier for newborns in the NICU. This proposal addresses research gaps identified by the National Institute of Child Health and Human Development, which seeks projects to develop novel and improved methods of neonatal patient identification.