Pediatric Adverse Event Risk Reduction for High Risk Medications in Children and Adolescents: Improving Pediatric Patient Safety in Dental Practices

儿童牙科患者的护理存在安全边际狭窄的情况，这种情况经常发生在实践环境中。 关于患者完整病史的信息较少，这对安全的牙科实践至关重要。虽然 在常规实践中，牙医管理和开出的药物数量有限，其中许多药物 存在人为错误和并发症的高风险。高风险药物经常被开出 由牙医给儿童使用，并导致严重的意外后果，包括不良反应 在清醒镇静或全身麻醉期间发生的事件，如死亡，以及过量使用阿片类药物。 在美国，每年进行的儿科牙科镇静治疗超过10万次。 用于这些程序的有苯二氮类药物、阿片类药物和全身麻醉药。所有这些都与严重的 不良事件，包括低氧血症、呼吸抑制、呼吸道阻塞和死亡。大多数美国人 在拔除第三颗磨牙后，他们在青年时期第一次接触阿片类药物。处方阿片类药物的使用 与成年期滥用阿片类药物的风险增加有关。这些趋势在成年初期和 儿童在牙科镇静手术后死亡的病例报告清楚地表明了 了解并实施儿童牙科护理中的最佳患者安全实践。然而，美国的数据显示 儿科牙科医生用药模式、循证处方与社区牙科 提供者对实施儿科患者安全的态度很少。虽然努力和资源 在儿科镇静方面，存在着减少阿片类药物过度处方和最佳患者安全做法的存在，大多数 干预措施的重点是内科医生和高级实践提供者(即护士从业者和医生 助理)，并可能在更广泛的儿科牙科实践中失败。这一混合的目标是- 方法通过确定现有的儿童处方，改善牙科医生的高危儿科处方模式 开出与不良健康结果相关的处方模式，可以作为干预的目标。至 为了实现这一目标，我们的目标是：(1)确定开出高风险药物的程度 在以人群为基础的商业样本中，儿童牙科患者和患者预后不良的比率- 和公共保险的儿童；(2)[检查]牙医在开出高剂量药物时对药物安全的态度。 为儿科患者开出高风险药物时的风险药物和决策； [制定并试行核对表，以促进治疗决策，最大限度地促进儿科用药安全 牙科护理]。我们预计，这项研究将缩小对高风险牙科处方模式的认识差距 儿童用药与患者预后差的关系，并决定了牙医对药物安全性的看法 在这些药物中。[这项混合方法研究将设计和实施一项循证干预措施 将高风险药物的危害降至最低，并改善儿童和青少年的安全牙科实践。]

A narrow margin of safety exists in the care of pediatric dental patients, and this often occurs in practice settings with less information on patients’ full medical history that is crucial for the safe practice of dentistry. Although dentists administer and prescribe a limited number of medications in routine practice, many of these medications carry a high risk for human error and complications. High-risk medications are frequently prescribed and administered by dentists to children and have resulted in serious unintended consequences, including adverse events – such as death – during conscious sedation or general anesthesia, and the overprescribing of opioids. More than 100,000 pediatric dental sedations are performed annually in the U.S. The most common medications used for these procedures are benzodiazepines, opioids, and general anesthetics. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction and death. Most Americans have their first exposure to opioids in their youth following third molar extraction. This use of prescription opioids has been associated with an increased risk of opioid misuse into adulthood. These trends in early adulthood and case reports of pediatric deaths occurring following dental sedation procedures make clear the urgency to understand and implement best patient safety practices in the dental care of children. Yet, U.S. data on medication prescribing patterns of pediatric dentists, evidence-based prescribing and community dental providers’ attitudes toward implementation of pediatric patient safety is scarce. Although efforts and resources exist to curtail overprescribing of opioids and best patient safety practices in pediatric sedation, most interventions are focused on physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) and may fail in broader implementation to pediatric dental practices. The objective of this mixed- methods study is to improve high-risk pediatric prescribing patterns among dentists by identifying current prescribing patterns associated with poor health outcomes that could be targeted for intervention. To accomplish this objective we aim to: (1) determine the extent to which high-risk medications are prescribed to pediatric dental patients and rates of poor patient outcomes in a population-based sample of commercially- and publicly-insured children; (2) [Examine] dentists’ attitudes towards medication safety when prescribing high- risk medications and decision-making when prescribing high-risk medications for pediatric patients; and (3) [Develop and pilot a checklist to facilitate treatment decisions that best promotion medication safety in pediatric dental care]. We anticipate this study will close the knowledge gap on dental prescribing patterns of high-risk medications to children, association with poor patient outcomes, and determine dentist perceptions of the safety of these medications. [This mixed-methods study will design and implement an evidence-based intervention to minimize harms from high-risk medications and improve safe dental practice to children and adolescents.]