Advances in Pediatrics - E-Book

Journal of Pediatric Infectious Diseases

---

The Critical Incident Analysis Technique 15 —a method first employed in aviation to examine aircraft training accidents and now frequently being applied to medicine—was the method used to analyze the error reports. In this investigation, the aim of the study was to identify the types of errors that occur in pediatric ambulatory care and the aspects of ambulatory medical care in which they occur. The physician reports provided the incidents for analysis. This involves reviewing all the error reports, focusing on several reports to begin to formulate meaning, and then incrementally including more reports to begin to develop preliminary categories.

Reports were coded into the preliminary categories to determine the need to add new categories, and related categories were grouped to develop overarching categories. The typology of categories was reviewed deductively to ensure coherence and parallelism. Finally, all of the data were coded using the developed categories. This process of independent coding, triangulation, and reliability testing was performed on two different sets of categories: Table 1 and the types of problems reported problem types: Coding discrepancies were reconciled by consensus of the research team.

The intercoder reliability for medical domains was 87 percent and for problem types, the intercoder reliability was 72 percent. Clinicians familiar with participating in research efforts of primary care networks successfully used a Web-based reporting system to document practice errors. In a brief post-study survey, the clinicians expressed a very high degree of satisfaction with the ease of using the online reporting tool.

Books on Ovid

Tables 3 and 4 provide the categories of medical error and the frequency of reports. Errors in the medical treatment domain were most frequent 38 percent followed by administrative errors 22 percent. Reported errors occurred most commonly in the domains of preventive screening and immunization and of medical treatment specifically, the medication process. Of the errors within the medical treatment domain Table 4 , 84 percent were medication errors. Communication problems were the most common cause of the reported errors, with problematic communication reported as contributing to 67 percent of the errors.

Table 5 provides examples, from the data, of error reports coded by medical domain and problem type. Types of errors within the medical treatment category and frequency of harm. Physicians reported errors, yet various members of the care team parents, nurses, pharmacists often discovered the errors. As we expected, physicians discovered most of the errors 52 percent. Parents and nurses discovered 15 percent and 13 percent, respectively. Other errors were discovered by transcriptionists 7 percent , pharmacists 4 percent , lab technicians 3 percent , and other physicians 1 percent.

Office receptionists, school personnel, a grandmother, and a patient found the remaining 3 percent of the errors. While we thought the person reporting the error the pediatrician would be the one who most often discovered the error, these results suggest the important role that the entire care team has in preventing errors from reaching the child. The occurrence of an error did not imply harm or injury to the patient. Anecdotally, physicians described their personal learning about identifying errors and noted an improvement in the culture of learning in their practices.

Participating clinicians also reported anecdotally an increased awareness of potential errors and harm in practice. One clinician mentioned the tendency to gloss over minor, inconsequential errors, especially during very busy times. She noted that study participation raised her consciousness about errors, and encouraged her to mention minor errors that would otherwise go unnoticed, to practice colleagues.

Another clinician reported that the busy nature of modern medicine, in itself, might contribute to medical errors and to the glossing over of minor medical errors, due to the clinician being too busy to notice or take action. Several clinicians reported a fair degree of subjectivity over the definition of an error, the degree of its seriousness, and whether to report it. Another important facet of raising clinicians' awareness about errors in their practice—and of reporting medical error data in general—is a clearer definition about what constitutes an error, what leads to an error, and what can be done to prevent it.

Several limitations require clarification.

JaypeeDigital | BookList

This study represents a first pass at developing a convenient and efficient reporting system for collecting medical errors in ambulatory pediatric practices. Because of the pilot nature of this study, only a small number of practitioners within the PROS Network were able to participate in the project. Furthermore, the fact that the person reporting the error was also directly responsible for the clinical care of the patient may have biased the errors that were, and were not, reported. Also, the PROS clinicians are familiar with participating in primary care network research efforts—this may have influenced their willingness to participate.

It is a widely held belief that medical errors are a significant problem, yet it is difficult to estimate the actual incidence of error. This study did not attempt to identify an error rate. Although we encouraged practitioners to report all errors, it is likely that some errors were undetected, and others were detected but were unreported. One clinician reported noticing errors by colleagues who either didn't notice them or didn't think they were important because there was not a negative consequence.

While this study cannot provide incidence rates of errors, the reports establish the occurrence of that error type and provide a rich, descriptive database of a variety of errors. An additional limitation of our reporting tool is that it didn't collect data on categories of harm. Instead, it just asked practitioners to report whether the error resulted in any harm. Obviously, not all medical errors result in harm to the patient, yet most have the potential to cause harm. The LEAP study confirms that medical errors occur in ambulatory pediatric settings. LEAP demonstrates that data collection of medical error reports can be successfully accomplished in busy ambulatory practice settings via a Web-based tool.

In addition, LEAP confirms what other studies have documented: Participating practitioners reported a high degree of satisfaction and a minimal number of problems with the Web-based tool. The success of this Web-based data collection tool points the way for future online data collection efforts.

Although error reporting was a component of this study, it is not the end-goal. Making care safer for children is our ultimate objective. LEAP suggests the utility of a simple mechanism for collecting and synthesizing errors.

Special offers and product promotions

Anecdotal reports from participating clinicians indicate that this process facilitated important reflection about safety issues in outpatient pediatric health care settings. Training in error identification and error mechanisms, and in the systems, culture, conditions, and practices of patient safety can provide the necessary tools for clinicians and office-based practice staff to learn about key safety issues of communication, hand offs, and teamwork.

Working collaboratively to test solutions may lead to the redesign of practice systems to improve the safety of the pediatric medical care delivered in their office. Information obtained from this study will be instrumental in the design of interventions to reduce errors and improve pediatric patient safety in the outpatient setting. The LEAP study documents that errors occur in ambulatory settings, most frequently in the context of medical treatment.

Pediatricians successfully used a Web-based reporting tool over a short period of time. Reported errors occurred most frequently in the domains of preventive screening and immunization, and of medical treatment specifically the medication process.

Communication problems were the most common cause of the reported errors. Our results suggest that all members of the health care team play a role in preventing errors from reaching the child. Further research will clarify categories of harm in ambulatory settings and explore venues for presenting errors and collaboratively designing and testing solutions. For future research, we will consider a larger study that will include a more representative sample of practices, as well as the participation by additional practice staff and possibly parents.

Improvement in ambulatory care safety will continue to be a challenge because pediatric ambulatory care clinics are busy, high-volume settings where hand offs are common. Pediatric protocols may often be individualized by clinicians, and children thus present unique opportunities for error. Furthermore, each clinic may be organized differently based on its location, practice type, and size.

Additionally, while it is possible to learn from other practices, each office practice must adapt system changes meant to improve quality and patient safety to meet local needs. It isn't enough to know what works in another setting. Each practice must recognize how to assess its own culture and design, and conduct effective tests of change. The LEAP study is an important initial step in learning how to ensure that health care is safer for children and families. Department of Health and Human Services. The authors wish to thank the PROS practitioners for their dedication to the success of this project and for the continued efforts in making health care safer for children.

The authors also wish to thank David Kleckner at the University of North Carolina for his technical assistance with the Web-based reporting tool.

The appendix cited in this report is provided electronically at http: Turn recording back on. National Center for Biotechnology Information , U. Author Information Authors Julie J. Maryland Avenue, Chicago, IL ; phone: Introduction An estimated 70 percent of pediatric care takes place in ambulatory settings.

Study objectives In , the Agency for Healthcare Research and Quality funded the University of North Carolina UNC Center for Education and Research on Therapeutics CERTs to conduct a study specifically designed to develop a secure Web-based reporting tool for collecting data on errors in ambulatory pediatric settings, and to identify the types of errors that can be generalized across multiple practices. Methods The reporting tool developed for this project is shown in Appendix A. For example, it was decided that this report included two separate errors: Table 1 Medical domains used for coding error reports.

Table 2 Problem types used for coding error reports. Results Clinicians familiar with participating in research efforts of primary care networks successfully used a Web-based reporting system to document practice errors. Table 3 Categories of medical error and frequency of harm. Table 4 Types of errors within the medical treatment category and frequency of harm. Table 5 Examples of error reports.

Account Options

Limitations Several limitations require clarification. Conclusion Information obtained from this study will be instrumental in the design of interventions to reduce errors and improve pediatric patient safety in the outpatient setting. Incidence of adverse drug events and potential adverse drug events: Adverse drug events in hospitalized patients. Medical errors affecting vulnerable primary care patients in six countries: To err is human: National Academy Press; Fill out our simple online form to recommend this journal to your library.

Historical Developments in Pediatric Psychology: Accepting high quality clinical and scientific papers relating to all aspects of Journal of Pediatric Psychology. Check out the journal's instructions to authors. Discover a more complete picture of how readers engage with research in Journal of Pediatric Psychology through Altmetric data. Now available on article pages. Register to receive table of contents email alerts as soon as new issues of Journal of Pediatric Psychology are published online.

Explore our press releases and a selection of recent media coverage, as well as useful information on major developments. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Palermo, PhD Editorial Board. Submit your research for an upcoming special issue JPP is currently welcoming submissions for the forthcoming Special Issue on Historical Developments in Pediatric Psychology: A Tribute to Dr. Introduction to the Special Issue on Adherence: A Tribute to Dennis Drotar.

• EQUINO DE COLUMNA LATERAL Y SU RELACIÓN CON EL DESCENSO DEL ALI (Podología Clínica nº 11) (Spanish Edition)
• Believe To Achieve
• Auguste Comte und die Gesetze der menschlichen Entwicklung: Theorie und Drei-Stadien-Gesetz (German Edition)
• International Perspectives on Higher Education: Challenging Values and Practice
• The CI Theory:Rise of the doomsday sun
• Using Your Imagination
• Jean-Luc Delarue, fragments de vérité (FIRST DOCUMENT) (French Edition)