Ambulatory Pediatric Safety Learning Lab

摘要 经过近20年的研究和质量改进，美国住院儿童从 与医疗保健相关的伤害。然而，绝大多数的医疗保健是在诊所和家里提供的，而且 在这一背景下，很少有研究证明如何提高安全性。儿童尤其容易患上 医疗保健造成的可预防的伤害有许多原因，包括基于体重的用药剂量、移交 在照顾者之间，以及他们有限的沟通不断演变的症状的能力之间。在家里，五分之二的孩子 患有慢性病的人都有用药错误。在这些人中，3.6%的人因这些错误而受伤-与 住院的儿童。在全国16.5万名患有1型糖尿病(T1D)的儿童中，20%的儿童患有贫困 血糖控制。T1D患者30岁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名儿童中就有一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，大多数没有接受并发症筛查。 家庭慢性病的管理是复杂的，并为系统提供了无数的机会 可能会导致患者伤害的故障发生。我们确定了3个关键机会，以减少2个最大的 在两种不同的情况下，这种情况下的严重危害--用药错误和治疗延误。 非卧床儿科患者安全学习实验室旨在： 1.根据委员会收集的临床信息，重新设计调整用药剂量的程序 患者/家属防止用药差错。(这将在1型糖尿病中进行研究) 2.建立患者/家庭用药监测和与诊所沟通的流程，以防止 药物不良事件。(这将在服用抗精神病药物的自闭症谱系障碍儿童中进行研究) 3.设计工作流程，以计划、检测和迅速处理患有严重疾病的儿童 家里的慢性疾病(这将在两个人群中进行研究) 这个学习实验室将设计和系统工程相结合--与Mad*Pow和大学合作 威斯康星州患者安全系统工程倡议-辛辛那提儿童在患者方面的专业知识- 集中研究实施。首要目标是重新设计护理和协调系统 在诊所和家庭之间，以消除这些环境中的医疗保健造成的危害。问题分析将 包括家庭和诊所中的民族志、访谈、FMEA和数字日记。我们将实施所有 在模拟环境中一起干预，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。其目的是开发一种 可扩展的模式，利用医疗系统和患者/家庭的优势，确保 所有的孩子。在完成这项提议后，我们的团队完全准备通过 患者安全(SPS)网络解决方案和改善全美的儿科门诊安全。

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.