title: Medication huddles slash adverse drug events (ADE), promote safety culture across all hospital units, including the ED.
abstract: To make a big dent in adverse drug events (ADE), Nationwide Children's Hospital devised medication huddles: a process that takes place after every reported ADE. A core huddle team meets with clinicians from the specific unit involved to discuss why the ADE occurred, and what can be done to prevent future events. In three years, the approach has reduced ADEs by 74%, and the rate of ADEs per 1,000 dispensed doses has decreased by 85%. * Administrators say a safety culture that encourages error reporting is key to making the process work. * To facilitate the huddle discussions, developers created a data collection tool that prompts huddle participants to describe the ADE, what factors were involved, and potential solutions. * While the medication huddles were first implemented in the hospital's critical care units, the process has since been expanded to include all areas of the hospital, including the ED.
mesh_terms: D003299:Cooperative Behavior; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D006776:Hospitals, Pediatric; D006801:Humans; D009820:Ohio; D019982:Organizational Case Studies; D015279:Organizational Culture; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration