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

项目总结 有医疗复杂性(CMC)的儿童特别容易出现用药差错和药物不良事件 因为他们极端的多药制，潜在的医疗脆弱性，以及对复杂药物的依赖 时刻表和路线。CMC发生药物不良事件导致紧急情况的几率高出5倍 科室(ED)探视比其他孩子多。在50次CMC急诊中，超过1次是由于药物不良事件，以及 38%的CMC急诊室因药物不良事件而住院。对…有准确的了解 准确给药是安全用药管理的绝对要求。前期工作 观察到给药的准确性，即知道适应症、配方、剂量、频率和 不到一半的CMC照顾者成功地描述了给药途径。低用药 给药的准确性会导致不良药物事件，包括可能可以预防的住院治疗， 急诊科就诊，发病率。目前，还没有工具来支持CMC的家庭以确保高 CMC日常护理所涉及的“二级”照顾者网络中的用药准确性 (例如，家庭、居家护理专业人员、学校护理员等)。为了解决这些未得到满足的关键需求，我们 将创建一个移动健康(MHealth)平台，药物安全@家(meds@home)，以改善CMC 通过支持整个护理网络的标准化用药管理，确保用药安全。我们 预计meds@home将提高给药的准确性，并减少与药物有关的 不良事件，并最终通过创建和促进 整个护理网络的标准化用药管理实践。为了实现这一目标，我们 建议开展以下目标：1)通过参与式共同干预设计医疗@家庭干预 在三个设计团队的并行设计过程中与利益相关者进行设计：一个团队与主要CMC 护理员，一名二级护理员，一名药物安全和CMC临床护理专家；2) 评估meds@home对高危药物给药准确性的影响 (例如，抗癫痫药物、阿片类药物)在一项随机对照试验中，检验药物治疗 通过使用meds@home，提高了初级和二级照顾者的管理准确性。 这些目标的完成将导致可扩展的mHealth干预，从而提高CMC的用药安全性 在看护网络上。Meds@home，如果完善，可以提高用药安全性和慢性病 在依赖护理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.