Long-term Reduction in Adverse Drug Events: An Evidence-Based Improvement Model Full Text
Gazarian M et al. – A multifaceted, evidence–based model for safe prescribing guideline implementation, engaging multidisciplinary clinicians, was effective in reducing medication error and harm in hospitalized children, resulting in sustained long–term improvement.Methods
- Prospective interrupted time series study evaluating the effectiveness of a multifaceted, staged intervention over 4 years in a major urban pediatric referral hospital.
- Guidelines for safe pediatric prescribing were implemented by using an evidence-based model.
- Key components included early clinician engagement and improved multidisciplinary communication, consensus development, interactive education, and timely data feedback by using iterative Plan-Do-Study-Act cycles.
- Impact on medication error and harm (adverse drug events, [ADEs]) was measured by using standard definitions and a multimethod approach.
- Prospective data from voluntary reports by nursing, medical, and pharmacy staff and intensive chart review were combined. All data were reviewed by a multidisciplinary panel, including causality assessments for ADEs.
- Reviewed over 3 time periods were 1011 patients with 6651 medication orders.
- Total ADEs decreased by > 50% in the first year and this was maintained at 4 years.
- Greatest improvements were in potential ADEs, which decreased from 12.26 per 100 patients at baseline to 4.60 per 100 patients at 4 years (P < .05).
- Total medication errors decreased from 4.51 per 100 orders at baseline to 2.78 per 100 orders at 4 years (P < .05).
- Prescribing errors decreased by 65%, from 4.07 per 100 orders at baseline to 2.05 orders at 4 years (P < .05).