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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Patient safety | 6/10 | https://en.wikipedia.org/wiki/Patient_safety | reference | science, encyclopedia | 2026-05-05T04:26:13.019610+00:00 | kb-cron |
Managed care plans may attempt to limit "unnecessary" services to cut the costs of health care, despite evidence that guidelines are not designed for general screening, but rather as decision-making tools when an individual practitioner evaluates a specific patient. The medical literature is evolving and often controversial; the development of guidelines requires consensus. Implementing guidelines and educating the entire health care team within a facility costs time and resources (which may be recovered by future efficiency and error reduction). Clinicians may resist evidence-based medicine as a threat to traditional relationships between patients, doctors, and other health professionals since any participant can influence decisions. Failing to follow guidelines might increase the risk of liability or disciplinary action by regulators.
== Quality and Safety Initiatives in Community Pharmacy practice == Community pharmacy practice is making important advances in the quality and safety movement, despite the limited number of federal and state regulations that exist and in the absence of national accreditation organizations such as the Joint Commission - a driving force for performance improvement in health care systems. Community pharmacies are using automated drug dispensing devices (robots), computerized drug utilization review tools, and, most recently, the ability to receive electronic prescriptions from prescribers to decrease the risk of error and increase the likelihood of delivering high-quality care. Quality Assurance (QA) in community practice is a relatively new concept. As of 2006, only 16 states have some form of legislation that regulates QA in community pharmacy practice. While most state QA legislation focuses on error reduction, North Carolina has recently approved legislation that requires the pharmacy QA program to include error reduction strategies and assessments of the quality of their pharmaceutical care outcomes and pharmacy services. New technologies facilitate the traceability tools of patients and medications. This is particularly relevant for drugs that are considered high-risk and costly.
== Quality improvement and safety initiatives in pediatrics == Quality improvement and patient safety is a major concern in the pediatric world of health care. This next section will focus on quality improvement and patient safety initiatives in inpatient settings. Over the last several years, pediatric groups have partnered to improve general understanding, reporting, process improvement methodologies, and quality of pediatric inpatient care. These collaborations have created a robust program of projects, bench-marking efforts, and research. Much of the research and focus on adverse events has been on medication errors–the most frequently reported adverse event for both adult and pediatric patients. It is also of interest to note that medication errors are also the most preventable type of harm that can occur within the pediatric population. It has been reported that when pediatric medication errors occur, these patients have a higher rate of death associated with the error than adult patients. A more recent review of potential pediatric safety issues conducted by Miller, Elixhauser, and Zhan found that hospitalized children who experienced a patient safety incident, compared with those who did not, had
Length of stay 2 to 6 times longer Hospital mortality 2 to 18 times greater Hospital charges 2 to 20 times higher In order to reduce these errors, the attention to safety needs to concentrate on designing safe systems and processes. Slonim and Pollack point out that safety is critical to reducing medical errors and adverse events. These problems can range from diagnostic and treatment errors to hospital-acquired infections, procedural complications, and failure to prevent problems such as pressure ulcers. In addition to addressing quality and safety issues found in adult patients there are a few characteristics that are unique to the pediatric population:
Development: As children mature both cognitively and physically, their needs as consumers of health care goods and services change. Therefore, planning a unified approach to pediatric safety and quality is affected by the fluid nature of childhood development. Dependency: Hospitalized children, especially those who are very young and/or nonverbal, are dependent on caregivers, parents, or other surrogates to convey key information associated with patient encounters. Even when children can accurately express their needs, they are unlikely to receive the same acknowledgment accorded to adult patients. In addition, because children are dependent on their caregivers, their care must be approved by parents or surrogates during all encounters. Different epidemiology: Most hospitalized children require acute episodic care, not care for chronic conditions as with many adult patients. Planning safety and quality initiatives within a framework of "wellness, interrupted by acute conditions or exacerbations" presents distinct challenges and requires a new way of thinking. Demographics: Children are more likely than other groups to live in poverty and experience racial and ethnic disparities in health care. Children are more dependent on public insurance, such as the State Children's Health Insurance Program (SCHIP) and Medicaid. One of the main challenges faced by pediatric safety and quality efforts is that most of the work on patient safety to date has focused on adult patients. In addition, there is no standard nomenclature for pediatric patient safety that is widely used. However, a standard framework for classifying pediatric adverse events that offers flexibility has been introduced. Standardization provides consistency between interdisciplinary teams and can facilitate multi-site studies. If these large-scale studies are conducted, the findings could generate large-scale intervention studies conducted with a faster life cycle.
=== Leaders in pediatric safety and quality === The Agency for Healthcare Research and Quality (AHRQ) is the Federal authority for patient safety and quality of care and has been a leader in pediatric quality and safety. AHRQ has developed Pediatric Quality Indicators (PedQIs) with the goal to highlight areas of quality concern and to target areas for further analysis. Eighteen pediatric quality indicators are included in the AHRQ quality measure modules; based on expert input, risk adjustment, and other considerations. Thirteen inpatient indicators are recommended for use at the hospital level, and five are designated area indicators. Inpatient indicators are treatments or conditions with the greatest potential of an adverse event for hospitalized children.