title: Long-term reduction in adverse drug events: an evidence-based improvement model.
abstract: OBJECTIVE
  To develop and test an evidence-based model for reducing medication errors and harm in hospitalized children.
  
  
  METHODS
  Prospective interrupted time series study evaluating the effectiveness of a multifaceted, staged intervention over 4 years in a major urban pediatric referral hospital. Guidelines for safe pediatric prescribing were implemented by using an evidence-based model. Key components included early clinician engagement and improved multidisciplinary communication, consensus development, interactive education, and timely data feedback by using iterative Plan-Do-Study-Act cycles. Impact on medication error and harm (adverse drug events, [ADEs]) was measured by using standard definitions and a multimethod approach. Prospective data from voluntary reports by nursing, medical, and pharmacy staff and intensive chart review were combined. All data were reviewed by a multidisciplinary panel, including causality assessments for ADEs.
  
  
  RESULTS
  Reviewed over 3 time periods were 1011 patients with 6651 medication orders. Total ADEs decreased by > 50% in the first year and this was maintained at 4 years. Greatest improvements were in potential ADEs, which decreased from 12.26 per 100 patients at baseline to 4.60 per 100 patients at 4 years (P < .05). Total medication errors decreased from 4.51 per 100 orders at baseline to 2.78 per 100 orders at 4 years (P < .05). Prescribing errors decreased by 65%, from 4.07 per 100 orders at baseline to 2.05 orders at 4 years (P < .05).
  
  
  CONCLUSIONS
  A multifaceted, evidence-based model for safe prescribing guideline implementation, engaging multidisciplinary clinicians, was effective in reducing medication error and harm in hospitalized children, resulting in sustained long-term improvement.
authors.affiliation: Paediatric Therapeutics Program, School of Women’s and Children’s Health, University of New South Wales, New South Wales, Australia. m.gazarian@unsw.edu.au
authors.forename: Madlen
authors.initials: M
authors.lastname: Gazarian
authors.forename: Linda Velta
authors.initials: LV
authors.lastname: Graudins
mesh_terms: D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007318:Inservice Training; D033183:Interdisciplinary Communication; D008508:Medication Errors / Q000517:prevention & control*; D009517:New South Wales