A multidisciplinary approach to adverse drug events in pediatric trauma patients in an adult trauma center.
BACKGROUND
Adult trauma centers are major providers of medical management for pediatric trauma patients in the United States. Medication administration in this patient population is complex and fraught with potential error.


METHODS
We designed a multidisciplinary team consisting of a pediatric hospitalist, pediatric care coordinator, pediatric nurse, pharmacist, and the trauma service to manage pediatric trauma patients from admission until discharge. The team mandated collective decision making for medication dosing and administration, weight documentation, and implemented a medication error reporting system. Our goal was to derive and implement a multidisciplinary practice and education-based model of pediatric trauma patient care to identify and decrease adverse medication events.


RESULTS
Two hundred fifty-nine pediatric trauma patients were studied from January 1, 2003 to December 31, 2004, 125 pre-team implementation (control group) and 134 post-team implementation (study group). There were no significant differences in age, sex, mechanism of injury, injury severity score, or hospital length of stay between groups. There were significant reductions in number of medication prescribing errors (25 vs 15 errors; P = 0.05) and number of medication administration errors (19 vs 9 errors; P = 0.05) in the study group. Weight documentation improved significantly in the study group (90% vs 81%; P = 0.048).


CONCLUSIONS
Instituting a multidisciplinary approach to pediatric trauma patient care is practical and can significantly decrease adverse medication events.
Kalina
Michael
M
Department of Surgery, Section of Trauma and Surgical Critical Care, Christiana Care Hospital and Health Care System, Newark, DE 19718, USA. mkalina@hotmail.com
Tinkoff
Glen
G
Gleason
Wendy
W
Veneri
Paula
P
Fulda
Gerard
G
D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000700:Analgesics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D033183:Interdisciplinary Communication; D008297:Male; D008508:Medication Errors / Q000145:classification / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000379:methods; D012189:Retrospective Studies; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000188:drug therapy*
D000700:Analgesics