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Title [sv]
Patientsäkerhet inom barnsjukvård
Publications (2 of 2) Show all publications
Nydert, P., Unbeck, M., Pukk Härenstam, K., Norman, M. & Lindemalm, S. (2020). Drug Use and Type of Adverse Drug Events-Identified by a Trigger Tool in Different Units in a Swedish Pediatric Hospital.. Drug, Healthcare and Patient Safety, 12, 31-40
Open this publication in new window or tab >>Drug Use and Type of Adverse Drug Events-Identified by a Trigger Tool in Different Units in a Swedish Pediatric Hospital.
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2020 (English)In: Drug, Healthcare and Patient Safety, E-ISSN 1179-1365, Vol. 12, p. 31-40Article in journal (Refereed) Published
Abstract [en]

Purpose: The objectives of our study were to determine drug use, type and incidence of all adverse event associated with drug or drug-related processes (Adverse Drug Events, ADE) among pediatric inpatients in relation to hospital unit and length of stay.

Patients and Methods: 600 pediatric (0-18 years) admissions at a Swedish university hospital during one year were included and stratified in blocks to 150 neonatal, surgical/orthopedic, medicine and emergency-medicine unit admissions, respectively. Adverse events were identified from medical records using a pediatric trigger tool. All triggers identifying an adverse event related to drugs and drug-related devices were included. Data on drug use were extracted from the hospital drug-data warehouse.

Results: In total, 17794 daily drug orders were administrated to 486 (81.0% exposed) admissions. Parental nutrition, potassium salts and morphine constituted half of all high-risk drugs prescribed. Two-thirds of intravenous irritating drug doses consisted of vancomycin, esomeprazole and meropenem. In 129 (21.5%) admissions, at least one ADE was identified, out of which 21 ADE were classified as more severe (National Coordinating Council Medication Error Reporting Prevention-Index, NCCMERP≥F). The ADE incidence was 47.4 (95% confidence interval: 39.4-57.3) per 1000 admission days and varied by unit category. In neonatal units, 56.9 (49.5-65.4) ADEs/1000 admission days were detected, in surgery/orthopedic 54.2 (40.3-72.8), in medicine 44.1 (33.1-58.7), and in emergency-medicine 14.3 (7.7-26.7) ADEs/1000 admission days were found. The most common types of ADEs were identified by triggers that were not directly aiming at drugs including insufficiently treated pain (incidence peaking already in the first days), skin, tissue or vascular harm (peaking at the end of the first week) and hospital-acquired infections (peaking in later admission days).

Conclusion: Adverse drug events are common in pediatric patients. The incidence of ADEs and type of ADE varies by hospital unit and length of hospital stay.

Keywords
adverse drug event, inpatients, patient safety, pediatrics, pharmaceutical preparation
National Category
Health Sciences
Identifiers
urn:nbn:se:du-33988 (URN)10.2147/DHPS.S232604 (DOI)32099481 (PubMedID)
Available from: 2020-06-15 Created: 2020-06-15 Last updated: 2024-01-09Bibliographically approved
Unbeck, M., Lindemalm, S., Nydert, P., Ygge, B.-M., Nylén, U., Berglund, C. & Härenstam, K. P. (2014). Validation of triggers and development of a pediatric trigger tool to identify adverse events.. BMC Health Services Research, 14, Article ID 655.
Open this publication in new window or tab >>Validation of triggers and development of a pediatric trigger tool to identify adverse events.
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2014 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, article id 655Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Little is known about adverse events (AEs) in pediatric patients. Record review is a common methodology for identifying AEs, but in pediatrics the record review tools generally have limited focus. The aim of the present study was to develop a broadly applicable record review tool to identify AEs in pediatric inpatients.

METHODS: Using a broad literature review and expert opinion with a modified Delphi process, a pediatric trigger tool with 88 triggers, definitions, and descriptions including AE preventability decision support was developed and tested in a random sample of 600 hospitalized pediatric patients admitted in 2010 to a single university children's hospital. Four registered nurse-physician teams performed complete two-stage retrospective reviews of 150 records each from either neonatal, surgical/orthopedic, medicine, or emergency medicine units.

RESULTS: Registered nurse review identified 296 of 600 records with triggers indicating potential AEs. Records (n = 121) with only false positive triggers not indicating any potential AEs were not forwarded to the next review stage. On subsequent physician review, 204 (34.0%) of patients were found to have had 563 AEs, range 1-27 AEs/patient. A total of 442 preventable AEs were found in 161 patients (26.8%), range 1-22. Overall, triggers were found 3,598 times in 417 (69.5%) records, with a mean of 6 (median 1, range 0-176) triggers per patient. The overall positive predictive value of the triggers was 22.9%, (range 0.0-100.0%). The final pediatric trigger tool, developed with a second Delphi round, required 29 triggers.

CONCLUSIONS: AEs are common in pediatric patients and most are preventable. The main contributions of this study are to further develop and adapt trigger definitions, including AE preventability decision support, to introduce new triggers in pediatric care, as well as to apply pediatric triggers in different clinical specialties. Our findings resulted in a national pediatric trigger tool, and might also be adapted internationally. The pediatric trigger tool can help healthcare organizations to measure and analyze the AEs occurring in hospitalized children in order to improve patient safety.

National Category
Health Sciences
Identifiers
urn:nbn:se:du-33970 (URN)10.1186/s12913-014-0655-5 (DOI)25527905 (PubMedID)
Available from: 2020-06-15 Created: 2020-06-15 Last updated: 2023-01-19Bibliographically approved
Principal InvestigatorUnbeck, Maria
Co-InvestigatorFörberg, Ulrika
Period
Identifiers
DiVA, id: project:2876

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