Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Child Abuse Negl. 2017 Jul;69:106-115. doi: 10.1016/j.chiabu.2017.04.014. Epub 2017 Apr 28.
The purpose of our study was to increase the rate of children with appropriate HIV-PEP regimens among those diagnosed with sexual assault in The Children's Hospital of Philadelphia Emergency Department (ED). The outcome measure was the percent of patients receiving correct HIV-PEP. We retrospectively reviewed 97 charts over 31 months to define the baseline rate of children receiving appropriate HIV-PEP regimens (pre QI-implementation period: 2/2012-8/2014). Among children in which HIV-PEP was indicated following sexual assault, 40% received the recommended 28-day course. Root cause analysis indicated prescribing errors accounted for 87% of patients not receiving appropriate HIV-PEP. Process drivers included standardizing care coordination follow-up calls to elicit specific information about HIV-PEP, ED educational initiatives targeted at HIV-PEP prescribing, revision of the clinical pathway to specify indicated duration of HIV-PEP, and revision of the order set to auto-populate the number of days for the HIV-PEP prescription. During the QI-implementation period (9/2014-4/2015), the rate of appropriate HIV-PEP increased to 64% (median 60%) and the average number of days between incorrect HIV-PEP regimens was 24.5. Post QI-implementation (5/2015-3/2016), the rate of appropriate HIV-PEP increased to 84% (median 100%) and the average number of days between incorrect HIV-PEP regimens increased to 78.4. A multifaceted quality improvement process improved the rate of receipt of appropriate HIV-PEP regimens for pediatric victims of sexual assault. Decision support tools are instrumental in sustaining ideal care delivery, but require ongoing evaluation and improvement in order to remain optimally effective.
我们研究的目的是提高在费城儿童医院急诊部（ED）诊断为性侵犯的儿童中接受适当 HIV-PEP 方案的比例。结果衡量标准是接受正确 HIV-PEP 的患者比例。我们回顾性地审查了 97 份图表，以确定在实施 QI 之前（预 QI 实施期：2012 年 2 月至 2014 年 8 月）接受适当 HIV-PEP 方案的儿童的基线比例。在因性侵犯而需要接受 HIV-PEP 的儿童中，40%接受了推荐的 28 天疗程。根本原因分析表明，处方错误导致 87%的患者未接受适当的 HIV-PEP。过程驱动因素包括标准化护理协调随访电话，以获取有关 HIV-PEP 的具体信息，针对 HIV-PEP 处方的 ED 教育计划，修订临床路径以指定 HIV-PEP 的指示持续时间，以及修订医嘱集以自动填充 HIV-PEP 处方的天数。在 QI 实施期间（2014 年 9 月至 2015 年 4 月），适当 HIV-PEP 的比例增加到 64%（中位数为 60%），不正确的 HIV-PEP 方案之间的平均天数为 24.5 天。在实施 QI 之后（2015 年 5 月至 2016 年 3 月），适当 HIV-PEP 的比例增加到 84%（中位数为 100%），不正确的 HIV-PEP 方案之间的平均天数增加到 78.4 天。多方面的质量改进过程提高了性侵犯儿科受害者接受适当 HIV-PEP 方案的比例。决策支持工具对于维持理想的护理提供至关重要，但需要不断评估和改进，以保持最佳效果。
