An article by Stockwell et al. (doi: 10.1542/peds.2014-2152) published this month in Pediatrics shows, unfortunately, that harm to hospitalized children caused by healthcare is all too common. The study used a Pediatric All-Cause Harm Measurement Tool developed by the authors to identify one in four hospitalized children suffer harm due to the care they receive, and that 45% of these harms are preventable.
The prevention of healthcare associated harm begins with a good metric- to understand the size of the problem and measure the impact of improvement strategies. Most hospitals measure harm to their patients using a combination of surveillance methods used to measure different types of harm, and most are manually gathered rather than automated. The tool developed and used by Stockwell et al. is a single metric which can automatically gather information on many types of harm from existing electronic data from the medical record.
Children outside of the hospital also experience harm in their healthcare. A recent study published in Pediatrics (doi: 10.1542/peds.2014-0309) found that, nationally, poison control centers receive a call every eight minutes for a pediatric medication error. In another study published in Pediatrics (doi: 10.1542/peds.2012-2434), my group found that children with cancer experience injuries due to medication errors at home at rates comparable to hospitalized patients. To eliminate harm to children caused by healthcare, researchers and clinicians need to broaden their focus to include all settings where healthcare is delivered.
What can we do to reduce the risk of harm to their children caused by healthcare? Clinicians and hospitals should get involved in improvement networks. Networks, such as the Children’s Hospitals Solutions for Patient Safety Network, have made great strides in reducing healthcare harm to hospitalized children. Parents should take an active role in their child’s healthcare. The Agency for Healthcare Research and Quality web site contains a list of 20 steps parents can take to reduce errors in their child’s care (http://archive.ahrq.gov/consumer/20tipkid.htm). The document recommends that parents ask all health care workers who contact the child if they have washed their hands.
Parents should ask questions about their child’s home medications, including understanding what the medicine is for, side effects, and what time to give the medicine, and what to use to measure the medicine. Parents, clinicians, and hospitals will need to partner together to eliminate harm to children caused by healthcare.