Departments of Pediatrics.
Population Health Sciences, Weill Cornell Medical Center and New York-Presbyterian Hospital, New York, New York.
Pediatrics. 2022 Aug 1;150(2). doi: 10.1542/peds.2021-054807.
Liquid medication dosing errors are common in pediatrics. Our outpatient clinic identified gaps in caregiver education based on a 2015 American Academy of Pediatrics policy statement on prescribing liquid medications. This quality improvement (QI) initiative sought to improve caregiver's understanding of liquid acetaminophen administration at the 2-month well-child visit from 30% to 70% over a 32-month period.
A resident-led interdisciplinary QI team performed sequential interventions to improve our outcome measure: the percentage of caregivers with an adequate understanding of 4 essential components of liquid acetaminophen administration (name, indication, dose, and frequency). Outcome data were collected via a 4-item verbal assessment of caregiver's understanding by nursing staff, with correct answers to all items considered adequate understanding. Process measures (medications prescribed and education provided), and balancing measures (anticipatory guidance items discussed) were gathered via electronic health record review. Shewhart "P" charts and established rules for detecting special cause variation were used to analyze data. Scatter plots assessed the association between the provision of syringes and caregiver understanding of medication administration.
In 636 caregivers, overall understanding of medication use improved from 39.8% to 74%. Knowledge of accurate dosage improved from 50.9% to 76.8%. Correlation between syringe provision and caregiver understanding was strong (R = .84).
Resident-led QI improved caregiver's understanding of liquid acetaminophen administration in infants. The most impactful interventions were implementation of English and Spanish pictograms and provision of dose-demarcated oral syringes, coupled with teach-back. Future interventions will examine generalizability to other medications and expansion to other services.
液体药物给药错误在儿科中很常见。根据 2015 年美国儿科学会关于开液体药物的政策声明，我们的门诊发现了护理人员教育方面的差距。这项质量改进（QI）计划旨在将 2 个月大的健康儿童就诊时护理人员对液体对乙酰氨基酚给药的理解从 30%提高到 70%，时间跨度为 32 个月。
由住院医师领导的跨学科 QI 团队进行了一系列干预措施，以提高我们的结果衡量标准：即护理人员对液体对乙酰氨基酚给药的 4 个基本要素（名称、适应证、剂量和频率）有足够理解的比例。通过护理人员对护理人员理解的 4 项口头评估来收集结果数据，所有项目回答正确被认为是充分理解。通过电子病历审查收集过程衡量标准（开处方的药物和提供的教育）和平衡衡量标准（讨论的预期指导项目）。使用 Shewhart“P”图和确定的特殊原因变异检测规则来分析数据。散点图评估了提供注射器与护理人员对药物管理理解之间的关系。
在 636 名护理人员中，药物使用的总体理解从 39.8%提高到 74%。准确剂量的知识从 50.9%提高到 76.8%。注射器的提供与护理人员的理解之间存在很强的相关性（R =.84）。
住院医师领导的 QI 提高了护理人员对婴儿液体对乙酰氨基酚给药的理解。最具影响力的干预措施是实施英语和西班牙语的象形图和提供剂量标记的口服注射器，并结合回授教学法。未来的干预措施将研究其在其他药物中的普遍性，并扩展到其他服务。
