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Abstract
<p class="first" id="P1">Participatory ergonomics (PE) can promote the application
of human factors and ergonomics
(HFE) principles to healthcare system redesign. This study applied a PE approach to
redesigning the family-centered rounds (FCR) process to improve family engagement.
Various FCR stakeholders (e.g., patients and families, physicians, nurses, hospital
management) were involved in different stages of the PE process. HFE principles were
integrated in both the content (e.g., shared mental model, usability, workload consideration,
systems approach) and process (e.g., top management commitment, stakeholder participation,
communication and feedback, learning and training, project management) of FCR redesign.
We describe activities of the PE process (e.g., formation and meetings of the redesign
team, data collection activities, intervention development, intervention implementation)
and present data on PE process evaluation. To demonstrate the value of PE-based FCR
redesign, future research should document its impact on FCR process measures (e.g.,
family engagement, round efficiency) and patient outcome measures (e.g., patient satisfaction).
</p>
Iatrogenic injuries, including medication errors, are an important problem in all hospitalized populations. However, few epidemiological data are available regarding medication errors in the pediatric inpatient setting. To assess the rates of medication errors, adverse drug events (ADEs), and potential ADEs; to compare pediatric rates with previously reported adult rates; to analyze the major types of errors; and to evaluate the potential impact of prevention strategies. Prospective cohort study of 1120 patients admitted to 2 academic institutions during 6 weeks in April and May of 1999. Medication errors, potential ADEs, and ADEs were identified by clinical staff reports and review of medication order sheets, medication administration records, and patient charts. We reviewed 10 778 medication orders and found 616 medication errors (5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5 (19%) were preventable. While the preventable ADE rate was similar to that of a previous adult hospital study, the potential ADE rate was 3 times higher. The rate of potential ADEs was significantly higher in neonates in the neonatal intensive care unit. Most potential ADEs occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%). Physician reviewers judged that computerized physician order entry could potentially have prevented 93% and ward-based clinical pharmacists 94% of potential ADEs. Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them.
Drawing on several decades of work with families, pediatricians, other health care professionals, and policy makers, the American Academy of Pediatrics provides a definition of patient- and family-centered care. In pediatrics, patient- and family-centered care is based on the understanding that the family is the child's primary source of strength and support. Further, this approach to care recognizes that the perspectives and information provided by families, children, and young adults are essential components of high-quality clinical decision-making, and that patients and family are integral partners with the health care team. This policy statement outlines the core principles of patient- and family-centered care, summarizes some of the recent literature linking patient- and family-centered care to improved health outcomes, and lists various other benefits to be expected when engaging in patient- and family-centered pediatric practice. The statement concludes with specific recommendations for how pediatricians can integrate patient- and family-centered care in hospitals, clinics, and community settings, and in broader systems of care, as well.
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