Divisions of Hospital Medicine.
Patient Services Leadership.
Hosp Pediatr. 2022 Jan 1;12(1):37-46. doi: 10.1542/hpeds.2021-006193.
High-risk therapies (HRTs), including medications and medical devices, are an important driver of preventable harm in children's hospitals. To facilitate shared situation awareness (SA) and thus targeted harm prevention, we aimed to increase the percentage of electronic health record (EHR) alerts with the correct descriptor of an HRT from 11% to 100% on a high-acuity hospital unit over a 6-month period.
The interdisciplinary team defined an HRT as a medication or device with a significant risk for harm that required heightened awareness. Our aim for interventions was to (1) educate staff on a new HRT algorithm; (2) develop a comprehensive table of HRTs, risks, and mitigation plans; (3) develop bedside signs for patients receiving HRTs; and (4) restructure unit huddles. Qualitative interviews with families, nurses, and medical teams were used to assess shared SA and inform the development and adaptation of interventions. The primary outcome metric was the percentage of EHR alerts for an HRT that contained a correct descriptor of the therapy for use by the care team and institutional safety leaders.
The percentage of EHR alerts with a correct HRT descriptor increased from an average of 11% to 96%, with special cause variation noted on a statistical process control chart. Using qualitative interview data, we identified critical awareness gaps, including establishing a shared mental model between nursing staff and the medical team as well as engagement of families at the bedside to monitor for complications.
Explicit, structured processes and huddles can increase HRT SA among the care team, patient, and family.
高风险疗法（HRTs），包括药物和医疗器械，是儿童医院可预防伤害的重要驱动因素。为了促进共享情境意识（SA），从而有针对性地预防伤害，我们的目标是在 6 个月内将高敏病房单元中电子健康记录（EHR）警报中正确描述 HRT 的百分比从 11%提高到 100%。
跨学科团队将 HRT 定义为一种具有重大伤害风险且需要高度警惕的药物或器械。我们干预的目的是：（1）向员工传授新的 HRT 算法；（2）制定 HRT、风险和缓解计划的综合表格；（3）为接受 HRT 的患者制定床边标志；（4）重组单元碰头会。对家庭、护士和医疗团队进行定性访谈，以评估共享的 SA，并为干预措施的制定和调整提供信息。主要结果指标是 EHR 警报中包含治疗团队和机构安全领导者使用的正确 HRT 描述符的 HRT 警报的百分比。
EHR 警报中包含正确 HRT 描述符的百分比从平均 11%增加到 96%，统计过程控制图上注意到特殊原因变化。使用定性访谈数据，我们确定了关键的意识差距，包括在护理人员和医疗团队之间建立共享心理模型，以及让患者家属在床边参与监测并发症。
明确、结构化的流程和碰头会可以提高护理团队、患者和家属对 HRT 的 SA。
