Pediatric Medication Safety: A Pharmacy’s Calling

1. Pediatric Medication Safety: A Pharmacy’s Calling Michael C. Dejos, PharmD, BCPS Medication Safety Officer

2. Objectives Pharmacist Objectives Identify strengths and limitations to voluntary event reporting Distinguish the various levels of error reduction strategies in medication safety Technician Objectives Describe the importance of medication safety in pediatric pharmacotherapy Choose appropriate medication safety resources for pediatrics

3. Oath of a Pharmacist: A Call for Medication Outcomes Improvement "I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: I will consider the welfare of humanity and relief of suffering my primary concerns. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients. I will respect and protect all personal and health information entrusted to me. I will accept the lifelong obligation to improve my professional knowledge and competence. I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct. I will embrace and advocate changes that improve patient care. I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.” https://www.pharmacist.com/node/25833?is_sso_called=1

4. Pharmaceutical Care: More than Dispensing Medications

5. Medication Errors vs. Adverse Drug Events Medication Errors ADEs NoHarm Preventable Harm Non-preventable Harm Contemporary View of Medication-Related Harm. A New Paradigm. NCCMERP. 2015

6. Medication Errors in Pediatric Patients Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 As many as 1 in 10 hospitalized children are impacted by a medication error Up to 35% of these errors are serious or life threatening Three times more likely than adults to experience harm from medication errors and adverse drug events Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

7. Reasons for Increased Risk of Medication Errors in Pediatric Patients • Different and changing pharmacokinetic parameters • Need for calculation of individualized doses based on the age, weight, body surface area (BSA) and clinical condition of patient • Lack of available dosage forms and concentrations • Dosage formulations extemporaneously compounded • Lack of stability, compatibility, and bioavailability data • Need for precise dose measurement and appropriate drug delivery systems • Lack of published information or FDA-approved labeling regarding dosing, pharmacokinetics, safety, efficacy, and clinical use Guidelines for preventing medication errors in pediatrics. J PediatrPharmacolTher 2001;6:426-42

8. Voluntary Event Reports: Reliable or Not? Pros Cons Awareness of event prior to reporting is required Reporter bias Fear of misuse and blame Does not detect frequency of events Rate of reporting only Underreporting • Ongoing data collection across time and entire organization • Often identifies clinically significant events • Relatively low cost • Widely used and studied • Firsthand knowledge of the event Am J Health-SystPharm: 2011; 68:227–40

9. Medication Safety Assessment Methods Internal Data External Data Pennsylvania Patient Safety Authority Institute for Safe Medication Practices Food and Drug Administration The Joint Commission • Voluntary Event Reports • Chart Review • Direct Observations • Trigger Tool Methodology • Clinical Pharmacist Interventions • Technology and Informatics Data Am J Health-SystPharm: 2011; 68:227–40

10. Medication Safety Dashboard at Nemours

11. Medication Safety Dashboard at Nemours

12. Becoming a Level 5 PreventErrors Eliminate Opportunities for Errors DetectErrors Self Inspection Level 4 Check forDefects Work Unit Inspects Company Inspects Customer Inspects Level 1 Level 2 Level 5 Level 3

13. Resources for Healthcare and Patient Safety Professionals on Medication Safety Institute for Safe Medication Practices National Patient Safety Foundation American Society of Health-System Pharmacists Pennsylvania Patient Safety Authority The Joint Commission Agency for Healthcare Research and Quality Institute for Healthcare Improvement http://www.ashp.org/menu/PracticePolicy/ResourceCenters/PatientSafety/MedicationUseSafety.aspx

14. Aim for High Level Error Reduction Strategies

15. ISMP Survey on Pediatric Medication Safety Practice Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 • Online survey during March and April 2015 • Respondents asked to select frequency with which they employed key error-prevention strategies • Results from 1,463 clinicians • Mostly nurses (43%), pharmacists (45%), and physicians in both inpatient and outpatient settings • Settings • Pediatric hospitals (43%) • General hospitals (41%) Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

16. ISMP Survey on Pediatric Medication Safety Practice Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

17. General best practice Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

18. Best practices when prescribing medications Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

19. Best practices when dispensing medications Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

20. Best practices when dispensing medications Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

21. Best practices when administering medications Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

22. Best practices when administering medications Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015 Part 2: Results of Survey on Pediatric Medication Safety. ISMP. 2015

23. Comparison between 2000 and 2015 Survey Findings Marked Improvements Part 1: Results of Survey on Pediatric Medication Safety. ISMP. 2015

24. Michael C. Dejos, PharmD, BCPS Medication Safety Officer Questions?

26. Nemours Center for Children's Health Media: KidsHealth www.kidshealth.org The Nemours Foundation, a nonprofit organization created by philanthropist Alfred I. duPont in 1936 and devoted to improving the health of children