Adducchio Sara, Grant Ethan D, Fonseca Laura D, Omoloja Abiodun, Kumar Gogi
Department of Neurology (SA, LDF, GK), Dayton Children's Hospital; Department of Pediatrics (EDG, GK), Wright State University Boonshoft School of Medicine, Dayton; and Department of Nephrology (AO), Dayton Children's Hospital, OH.
Neurol Clin Pract. 2024 Apr;14(2):e200270. doi: 10.1212/CPJ.0000000000200270. Epub 2024 Mar 15.
Medication reconciliation errors are a common problem in health care, particularly during transitions of care. Discharge medication reconciliation (DMR) errors in a pediatric setting can range from 26% to 42.2%. We conducted a quality improvement project to decrease DMR error rate at Dayton Children's Hospital in Dayton, Ohio.
We conducted 2 interventions, each with 3 Plan-Do-Study-Act cycles from September 2021 through February 2023. The first intervention focused on using current specialty neurology nurses as scribes and creating a template note to include the plan of care and review of DMR before discharge. Our second intervention consisted of standardizing the seizure rescue medication order by creating an order panel within our electronic medical record system for all the rescue medications presently available. Medication errors were documented by the specialty neurology nurse during a phone conversation on the next business day post discharge. DMR error rates were calculated for each week using a control chart. Medication errors and patient harm were classified according to the National Coordinating Council for Medication Error Reporting and Prevention Index.
One hundred six errors were noted. Of these, 98 (92%) occurred in patients with seizure and 64 (60%) were related to prescription of seizure rescue medication specifically. The baseline error rate was calculated at 15.7% or 7 errors per month (January 2021 through June 2021). The average error rate dropped from 15.7% to 5.3% (2 errors per month) after initiation of our first intervention (September 2021). Twelve weeks after initiation of the second intervention, a 2.9% (1 error per month) was noted. Afterward, there was a ten-week period of 0% errors.
Sustainable reduction of DMR errors in pediatric patients with epilepsy was achieved by using specialty neurology nurses to scribe the care plan and creating order panels to facilitate accuracy of discharge medication orders without additional cost to the hospital.
用药核对错误是医疗保健中的常见问题，尤其是在医疗护理转接期间。儿科环境中的出院用药核对（DMR）错误率在26%至42.2%之间。我们开展了一项质量改进项目，以降低俄亥俄州代顿市代顿儿童医院的DMR错误率。
我们进行了两项干预措施，每项措施从2021年9月至2023年2月都包含3个计划-执行-研究-行动周期。第一项干预措施重点是让现任专科神经科护士担任记录员，并创建一个模板记录，以纳入护理计划和出院前的DMR复查。我们的第二项干预措施包括通过在电子病历系统中为目前所有可用的急救药物创建一个医嘱面板，来规范癫痫急救药物医嘱。专科神经科护士在出院后的下一个工作日通过电话沟通记录用药错误情况。每周使用控制图计算DMR错误率。用药错误和患者伤害根据国家用药错误报告和预防协调委员会指数进行分类。
共记录到106起错误。其中，98起（92%）发生在癫痫患者中，64起（60%）具体与癫痫急救药物的处方有关。基线错误率计算为15.7%或每月7起错误（2021年1月至2021年6月）。在我们的第一项干预措施开始后（2021年9月），平均错误率从15.7%降至5.3%（每月2起错误）。第二项干预措施开始12周后，错误率为2.9%（每月1起错误）。此后，有一个为期十周的零错误期。
通过利用专科神经科护士记录护理计划并创建医嘱面板，在不增加医院额外成本的情况下，实现了儿科癫痫患者DMR错误的持续减少，以促进出院用药医嘱的准确性。
