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From Innovation to Dissemination: Meds IQ, a New Platform for Paediatric Medicines Safety QI

Author: Kasia Muszynska
Project Manager
Royal College of Paediatrics and Child Health


Jonny is 6 years old and he is about to go to a hospital for a second time in his life. He may not remember the first time, as he was only a baby, but it left him with a powerful reminder that hospitals are not a safe place to be - due to the wrong dosage of a medication he was given, he had partly lost his hearing.

Luckily, Jonny's story is fictitious, but there are thousands of stories like this one which are not. Medication errors are not uncommon in child healthcare. And when they do occur, their consequences can be severely damaging to a little patient's health.

In 2007, 72000 medication errors were reported in England although the number might be in fact much higher [1]. Medication error has become an area of concern in healthcare practice - so much so that reducing its incidence has been identified as an improvement area in the NHS Outcomes Framework 2014/15. The risk of a medication error is even greater in paediatrics, where drug doses may need to be calculated based on patient's age, weight, and body surface area. The consequences of medication errors in children can also be greater than in adults - a recent study suggests the potential adverse drug reaction rate to be three times higher [2].



What is Meds IQ?


In 2014, the Department of Health commissioned the Royal College of Paediatrics and Child Health (RCPCH) to develop a QI network to reduce harm from paediatric medication error in the UK. Meds IQ project was founded and subsequently launched at the RCPCH conference in April this year.

In the beginning, we asked child health professionals - GPs, paediatricians, nurses, and pharmacists - about their experience of medication error. What we found out was that across all these groups, prescribing errors were the most commonly experienced (75% of our survey's respondents), particularly around drug dosage miscalculations, illegibly written prescriptions, and mistakes from previous prescriptions. We have also been told that medication information and support in communicating with families were an area of need for the child health community.

With that feedback in mind, we developed the Meds IQ website, collating practical QI resources focused on 4 areas: safe prescribing, medication error reporting, medicine reconciliation, and engaging patients and families in improving medication safety.

The principle behind Meds IQ is simple: we know there have been numerous innovative, quality improvement projects developed in local settings, matching the real need and resourcing available in day-to-day clinical practice. These small-scale initiatives could often be a real game-changer for clinicians struggling with similar challenges in other locations, yet many remain unknown to a larger audience. Therefore, rather than painstakingly develop new solutions, Meds IQ aims to bring together the abundance of existing QI initiatives in a single website, which clinicians can access to improve knowledge, seek solutions, and share their experiences in improving paediatric medication safety.

What's next?

But creating the website was just the beginning. Our next steps consist of building a community of practice around Meds IQ on the one hand, and developing a pathway for good practice to be scaled-up and for the practical tools to be quality assured and accessible to wider audiences. To this end, we are rolling out a UK-wide campaign where we will be asking child health professionals, who are passionate about quality improvement in medicines safety, to help us further grow our online library, implement the resources they find there in their own practice, and promote the use of Meds IQ to their peers. We are also working with RCPCH and other national and international organisations towards creating a review and accreditation process, whereby new solutions, developed in response to real need on the ground, can receive formal recognition and help to build a more standardised approach to solving key issues in paediatric medicines safety.

What does the future hold?

There's a long way ahead of Meds IQ - our vision is that it will become the go-to place for paediatric medicines safety information and a platform for the paediatric community to share problems and together seek solutions - in the UK and internationally. We're already working with the American Academy of Pediatrics and a range of UK nationwide organisations. We're hoping that, in time, our international collaborative will grow to include more partners.

For more information about the project, contact Kasia Muszynska, the Meds IQ Project Manager at: kasia.muszynska@rcpch.ac.uk 

To watch the Meds IQ video, please visit: http://www.medsiq.org/content/about-us 



Meds IQ project is part of a wider RCPCH Paediatric Care Online programme, working in partnership with the American Academy of Pediatrics, Royal College of General Practitioners, Royal Pharmaceutical Society, and the Royal College of Nursing.


The project is developed in cooperation with a range of stakeholders including members of NHS England Patient Safety, Neonatal and Paediatric Pharmacists Group, UCLPartners Academic Health Science Network, the Paediatric International Patient Safety and Quality Community (PIPSQC), and MiST (Making it Safer Together) paediatric patient safety collaborative.

References:
1. Romero-Perez R, Hildick-Smith P. (2012). "Minimising prescribing errors in paediatrics - clinical audit". In: Scottish Universities Medical Journal, 1: 14. Available at: http://sumj.dundee.ac.uk/data/uploads/epub-article/014-sumj.epub.pdf
2. Kaushal, R. et al. (2001). "Medication errors and adverse drug events in pediatric inpatients". In: JAMA, 285 (16): 2114-2120. Available at: http://jama.jamanetwork.com/article.aspx?articleid=193775



Related Links:

1. AAP - Improving Access to Safe Drugs and Medical Devices for Children
2. AAP - Pediatric Care Online 
3.
ACS National Surgical Quality Improvement Program (ACS NSQIP) Pediatric 

4. ACSQHC - Medication Safety
5.
AHRQ - Children's Electronic Health Record (EHR) Format 

6. APSF - Monitoring for Opioid-Induced Ventilatory Impairment (OIVI) 
7. ASHP - Medication Use Safety Resources 
8.
CAPHC - Paediatric Medication Reconciliation Collaborative
9.
CAPHC - Paediatric Opioid Safety Resource Kit 

10. CDC - Medication Safety Program 
11. CDC - PROTECT Initiative (to prevent unintentional medication overdoses in children) 
12. Children's Hospitals' Solutions for Patient Safety (SPS) - Prevention Bundles - Adverse Drug Events 
13. Collaborative Pharmaceutical Care in Hospitals Cuts Medication Errors by Three Quarters - New Study 
14.
ConsumerMedSafety.org - Top 10 Steps Parents Should Take to Prevent Medicine Mishaps
15.
Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age 

16. Don't just stand there - #ReACT! ReACT - the Respond to Ailing Children Tool 
17. eBroselow 
18. ECRI - Medication / Drug Safety 
19.
Emergency Departments Improve Readiness to Care for Children
20.
FDA - Pediatric Safety 

21. FDA - Safe Use Initiative 
22. FDA - Ten Tips to Prevent an Accidental Overdose 
23. Health IT Safety Center Roadmap 
24. HealthIT.gov - SAFER Guides for EHRs 
25. How Medical Tech Gave a Patient a Massive Overdose 
26. iDoseCheck 
27. International Medication Safety Network (IMSN) - Member Resources
28.
ISMP - Part 1: Results of Survey on Pediatric Medication Safety: More is Needed to Protect Hospitalized Children from Medication Errors

29. ISMP - Part 2: Results of Pediatric Medication Safety Survey: Comparing Data Subsets Points Out Areas for Improvement 
30. ISMP - Report a Medication or Vaccine Error or Hazard 
31. ISMP Canada - Advancing Medication Safety in Paediatrics 
32. ISMP Canada - Opioid Stewardship 
33. Keeping Kids Safe During Critical Illness and Resuscitation 
34. Leveraging Big Data Analytics to Uncover New Insights in Patient Safety 
35. MARQUIS Medication Reconciliation Toolkit 
36. Medicines for Children
37.
Medistori Toolkit (helping patients manage medications, appointments, and symptoms)

38. Meds IQ (sharing QI resources for paediatric medication safety) 
39. MEPA - Managing Emergencies in Pediatric Anaesthesia 
40. Michigan Pediatric Safety Collaboration - Standardize Compounded Oral Liquids 
41. MiST (Making it Safer Together) Paediatric Patient Safety Collaborative 
42. MITRE - National Patient Safety Partnership Aims to Save Lives with Data 
43. National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) 
44. NCCMERP Adverse Drug Event Algorithm (ADE Algorithm) 
45. National Pediatric Readiness Project - Ensuring Emergency Care for All Children 
46. NHS England - Patient Safety 
47. NHS England - Children and young people's patient safety expert group 
48.
NHS - Children and Young People's Services Safety Thermometer
49.
NHS Improving Quality (NHSIQ) 

50. NHS Institute for Innovation and Improvement - Safer Care 
51. NHS - Medication Safety 
52. NHS - Patient Safety First 
53. NPSF - Center for Education and Research on Therapeutics [CERT] Aims to Improve Medication Safety
54.
OPENPediatrics 

55. Paediatric Emergency Medication Handbook - Monash Children's Hospital 
56. Partnership for Patients (PfP) - Adverse Drug Events (ADEs) 
57. Partnership for Patients (PfP) - Pediatric Safety 
58. Partnership for Patients (PfP) - Adverse Drug Event Priority Areas for Pediatric Patients 
59. PaSQ (European Union Network for Patient Safety and Quality of Care) - Patient Safety and Quality of Care Good Practices Search Interface
60.
Patient Safety Movement - Medication Errors
61.
PediSafe app 

62. PediStat app 
63. PEMSoft app 
64. PMH - Calculators 
65. Preventing High-alert Medication Errors in Hospital Patients 
66. RCPCH - Paediatric Care Online 
67. ReACT - Respond to Ailing Children Tool 
68. Running Horse Group (paediatric quality improvement network) 
69. S.A.F.E - Improving Child Health Outcomes through Situation Awareness 
70. Safe Kids Worldwide - Medication Safety 
71. Safe Patient Resource Center: 20 Tips to Help Prevent Medical Errors in Children
72.
SAFER Electronic Health Records: Safety Assurance Factors for EHR Resilience 

73. Situation Awareness for Everyone (S.A.F.E) Programme
74. SPSP - Maternity and Children Quality Improvement Collaborative (MCQIC) 
75. UK Sepsis Trust - Acute Paediatric Toolkit - Paediatric Sepsis 6 
76. Wake Up Safe - Pediatric Anesthesia Quality Improvement Initiative 
77. WHO - Essential medicines for children 
78.
WHO - Medicines Safety Publications 
79.
WHO - Paediatric medicines Regulators' Network (PmRN) 
80.
WHO - Patient Safety - Implementing Change 

 

Related Publications:

1. AHRQ PSNet - Pediatrics - Medication Safety 
2. Adverse drug events in a paediatric intensive care unit: a prospective cohort 
3. Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study 
4. Analysis of medication errors in simulated pediatric resuscitation by residents 
5.
Barcode medication administration work-arounds: a systematic review and implications for nurse executives 
6.
CAPHC - Paediatric Medication Reconciliation Collaborative - Key Strategies and Essential Success Elements: The 3-Year Journey 

7. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study 
8.
Color coded medication safety system reduces community pediatric emergency nursing medication errors
9.
Color-coded prefilled medication syringes decrease time to delivery and dosing error in simulated emergency department pediatric resuscitations 

10. Computerized surveillance for adverse drug events in a pediatric hospital 
11.
Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study
12.
Developing person-centred analysis of harm in a paediatric hospital: a quality improvement report 
13. Development of an Electronic Pediatric All-Cause Harm Measurement Tool Using a Modified Delphi Method 
14.
Effects of a pharmacist-led pediatrics medication safety team on medication-error reporting 
15.
Electronic prescribing in pediatrics: toward safer and more effective medication management

16. Emergency hospitalizations for unsupervised prescription medication ingestions by young children 
17. Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis 
18. Family-initiated dialogue about medications during family-centered rounds 
19.
IHI - How-to Guide: Prevent Adverse Drug Events (Medication Reconciliation) (Pediatric Supplement) 
20.
IHI - How-to Guide: Prevent Harm from High-Alert Medications (Pediatric Supplement) 
21.
Impact of a pediatric antibiotic standard dosing table on dosing errors 
22.
Impact of a prescription review program on the accuracy and safety of discharge prescriptions in a pediatric hospital setting 
23.
Implementation of a "second victim" program in a pediatric hospital
24. 
Implementing medication reconciliation in outpatient pediatrics 

25. Improvement of medication event interventions through use of an electronic database
26. 
Improving Pediatrics Medication Safety Part I: Research on Medication Errors and Recommendations from the Joint Commission 
27. 
Improving Pediatric Medication Safety Part II: Evaluating Strategies to Prevent Medication Errors 
28.
Increasing medication error reporting rates while reducing harm through simultaneous cultural and system-level interventions in an intensive care unit
29. 
Influence of a systems-based approach to prescribing errors in a pediatric resident clinic
30. Institute for Safe Medication Practices and Poison Control Centers: Collaborating to Prevent Medication Errors and Unintentional Poisonings 

31. Internal quality improvement collaborative significantly reduces hospital-wide medication error related adverse drug events
32.
Interruptions and medication administration in critical care 

33. Interventions for reducing medication errors in children in hospital
34.
Interventions to reduce medication errors in pediatric intensive care 

35. Interventions to reduce pediatric medication errors: a systematic review 
36. IOM - Identifying and Preventing Medication Errors
37.
IOM - Safe and Effective Medicines for Children 

38. ISMP Canada - Medication Safety in Pediatrics 
39. Junior doctor essentials: critical incident reporting
40.
Medication administration errors and the pediatric population: a systematic search of the literature 

41. Medication errors in emergency rooms, intensive care units and pediatric wards
42.
Medication errors in hospitalised children
43. Medication errors in the management of anaphylaxis in a pediatric emergency department 
44. Medication Errors in Pediatric Emergencies: a Systematic Analysis 
45. Medication errors - new approaches to prevention 
46.
Medication manager: results of a medication at the bedside pilot in a pediatric teaching institution 
47.
Medication Reconciliation in the Hospital: What, Why, Where, When, Who and How?
48.
Medication-related emergency department visits and hospital admissions in pediatric patients: a qualitative systematic review 
49. Medication safety for children in China
50.
Medication safety in the operating room: a survey of preparation methods and drug concentration consistencies in children's hospitals in the United States

51. Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting 
52. National Assessment of Pediatric Readiness of Emergency Departments
53.
Optimization of drug-drug interaction alert rules in a pediatric hospital's EHR using a [QlikView] visual analytics dashboard 

54. Out-of-hospital medication errors among young children in the United States, 2002-2012 
55. Patient Safety Movement - Actionable Patient Safety Solution (APSS) #2: Medication Errors
56. 
Pediatric adverse drug events in the outpatient setting: an 11-year national analysis 

57. Pediatric emergency nurses' self-reported medication safety practices
58.
Pediatric medication administration errors and workflow following implementation of a bar code medication administration system 

59. Pediatric medication safety in the emergency department 
60.
Pediatric medication safety: the power of the team 
61.
Potential drug-drug interactions in infant, child, and adolescent patients in children's hospitals
62.
Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool 

63. Preventability of voluntarily reported or trigger tool–identified medication errors in a pediatric institution by information technology: a retrospective cohort study 
64. Preventing medication errors in neonatology: is it a dream? 
65. Prevention of Medication Errors in the Pediatric Inpatient Setting 
66. Relationship between the nursing work environment and the occurrence of reported paediatric medication administration errors: a pan Canadian study 
67. Role of "Smart" Infusion Pumps in Patient Safety 
68. Safe practice standard for barcode technology 
69.
SafeCare Standards - Medication Management 
70.
Specific features of medicines safety and pharmacovigilance in Africa 
71.
Standard concentrations of high-alert drug infusions across paediatric acute care
72.
Strategies to reduce medication errors in pediatric ambulatory settings 

73. Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative 
74. Systematic approach to improving medication safety in a pediatric intensive care unit 
75.
Tenfold medication errors: 5 years' experience at a university-affiliated pediatric hospital
76.
Toolkit to Disseminate Best Practices in Inpatient Medication Reconciliation: Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) 

77. Trigger Tool as a Method to Measure Harmful Medication Errors in Children 
78. WHO - Patient Safety Tool kit 
79.
WHO - Promoting the safety of medicines for children 
80.
WHO - Reporting and learning systems for medication errors: the role of pharmacovigilance centres