Enhancing Pediatric Medication Safety and Reducing Costs in Urgent Care with PM Pediatric Care
Medication errors are among the most common and preventable safety events in healthcare, especially in pediatrics where medication dosing is weight-based, and medication preparation and administration can be complex (Rickey et. al, 2023).
In pediatrics, medication dosing is weight-based, meaning the medication dose ordered by the provider is driven both by the clinical condition being treated as well as the patient’s unique weight in kilograms. The developmental needs of the pediatric patient population require stocking multiple formulations of any given medication to account for patients who require liquid medication formulation instead of pills. Liquid medication formulations require an additional conversion from milligrams to milliliters prior to administration (Conn et. Al, 2018).
In addition, clinicians in the ambulatory healthcare environment often do not have continuous, onsite support of pharmacists and/or licensed nurses to verify and prepare all ordered medications before they are administered to the patient. In some environments, providers are responsible for both ordering and administering medications, while in others medication administration may be delegated to unlicensed clinical support staff (such as medical assistants). Both approaches increase the risk of dosing or administration medication error, as verification of the medication is limited to a single ordering provider.
Standardizing medication administration in the ambulatory environment posed several challenges.
■ Limited Onsite Support: Ambulatory healthcare environments do not have continuous onsite pharmacy/nursing support.
■ Weight-Based Dosing: In pediatric care, there are many steps required to correctly calculate weight-based doses for the many different therapies available, which could lead to medication errors.
■ Maintenance Burden: With paper pathways and references, there was increased risk of clinical team members using outdated information.
■ Scope of Practice: Determined at a state level, scope of practice of medical assistants varies by state. Where allowable, medical assistants are not permitted to verify dose or calculate medication volume, requiring custom medication orders to account for volume of liquid medications and reliance on a single provider to order and verify medications.
■ Healthcare Provider Burnout: Healthcare Providers spent too much time on medication administration tasks that with the right safeguards, process and tools could be delegated to Clinical Support Staff, such as Medical Assistants.
As part of its mission to deliver world-class, evidence-based care, PM Pediatric Care, a national leader in pediatric urgent care, wanted to ensure continued safe administration of medication, as well as improved process efficiencies across all urgent care locations. It is well documented in the literature that computerized provider order entry (CPOE) combined with Clinical Decision Support Systems (CDSS) could prevent 66-73% of errors (Fortescue et al, 2003). Additionally, medication dose rounding to measurable volumes and dose standardization are proven methods to improve pediatric medication safety (Campbell et. al, 2022 & Miller et. al, 2007). PM Pediatric Care paired these proven methods to safeguard medication administration while improving efficiency. First, PM Pediatric Care created an in-office medication formulary, establishing standard medication doses for every medication administered in-office, based on patient weight and clinical indication being treated. These doses were calculated to ensure both effectiveness and ease of medication administration in the office during fast-paced urgent care visits.
PM Pediatric Care partnered with Avo to digitize their weight-based medication formulary to ensure continued patient safety and improve operational efficiency.
Implementation
To address the challenges of incorporating this in-office medication formulary into the clinical workflow and ensure all clinical staff involved in this process have easy access to a validated, up-to-date resource, PM Pediatric Care collaborated with Avo, a clinician support platform, to help optimize patient safety and facilitate in-office medication verification. Using Avo, the in-office medication formulary was digitized and integrated into Avo’s clinical decision support platform, making it easier for all clinical team members to access the formulary at the point of care on mobile, iPads, and desktop devices. After one month of testing the in-office medication formulary on Avo at a single site, PM Pediatric Care decided to deploy the tool across all their urgent care offices nationwide.
Clinical team members who are authorized to administer medications, regardless of role, now use an in-office medication formulary housed in Avo to identify and verify the appropriate weight-based medication dose at the point-of-care. Within this digital tool, clinicians select a weight range, desired medication and formulation/route, and instantly receive a medication dose (in milligrams) as well as key details such as volume (in # tablets, milliliters, etc.) as well as absolute maximum dose, administration details, preparation details, indications, and images of the selected medication.
Outcomes
■ Clinician Adoption: Avo was used 39,000 times by PM Pediatric Care staff within a year of implementation.
■ Upskilling Clinical Support Staff: A 54% increase in Medical Assistant medication administration allowed physicians to reduce their time on these tasks by 31%, allowing them to focus on patient assessment, diagnosis, and treatment.
■ Reduction in Costs: Staffing costs associated with medication administration were reduced by 71%, decreasing the time required for these tasks.
Clinician adoption skyrockets: Avo was used 39,000 times by PM Pediatric Care staff within one year of implementation.
As a result of this effort, PM Pediatric Care further reduced patient safety risks while significantly lowering the costs of administering medications and optimizing clinical staff efficiency.
The successful implementation of the in-office medication formulary and partnership with Avo has set a new standard for medication safety and efficiency. PM Pediatric Care remains focused on quality and safety and plans to conduct further analysis to quantify the impact of this initiative.
References
Campbell, C. T., Wheatley, K. H., Svoboda, L., Campbell, C. E., & Norris, K. R. (2022). Strategies for implementing pediatric dose standardization: Considerations from the Vizient University Health System Consortium Pharmacy Network Pediatric Pharmacy Committee. Journal of Pediatric Pharmacology and Therapeutics, 27(1), 19-28. https://doi.org/10.5863/1551-6776-27.1.19
Conn RL, Kearney O, Tully MP, et al. What causes prescribing errors in children? Scoping review. BMJ Open 2019;9:e028680. doi:10.1136/ bmjopen-2018-028680
Accessible at: https://bmjopen.bmj.com/content/bmjopen/9/8/e028680.full.pdf
Fortescue EB, Kaushal R, Landrigan CP, McKenna KJ, Clapp MD, Federico F, Goldmann DA, Bates DW. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003 Apr;111(4 Pt 1):722-9. doi: 10.1542/peds.111.4.722. PMID: 12671103.
Miller, M. R., Robinson, K. A., Lubomski, L. H., Rinke, M. L., & Pronovost, P. J. (2007). Medication errors in paediatric care: A systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Quality and Safety in Health Care, 16(2), 116-126. https://doi.org/10.1136/qshc.2006.019950
Accessible at: https://qualitysafety.bmj.com/content/qhc/16/2/116.full.pdf
Rickey, L., Auger, K., Britto, M. T., Rodgers, I., Field, S., Odom, A., Lehr, M., Cronin, A., & Walsh, K. E. (2023). Measurement of Ambulatory Medication Errors in Children: A Scoping Review. *Pediatrics, 152*(6), e2023061281. https://doi.org/10.1542/peds.2023-061281
Tariq RA, Vashisht R, Sinha A, et al. Medication Dispensing Errors and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519065/
About PM Pediatric Care
PM Pediatric Care is the nation’s largest provider of specialized pediatric urgent care with nearly 90 locations in 14 states. Established as a premier alternative to a children’s emergency department, the organization has since grown into a robust network of world-class pediatric healthcare initiatives, including comprehensive behavioral health services to address the rise of related conditions among the pediatric and adolescent population, emerging population health interventions, and partnerships with leading children’s health systems and school districts across the nation. As a recognized thought leader in the field of pediatric medicine, PM Pediatric is a 10-time honoree to Inc’s 500/5000 list of the nation’s fastest-growing private companies. For more information, visit www.pmpediatrics.com.
About Avo
Avo’s clinician support platform empowers healthcare organizations to standardize care and reduce burnout by effortlessly incorporating guidelines and protocols into the clinical workflow. By centralizing the latest information and transforming it into actionable tools in the EHR (or outside of it), Avo simplifies everyday tasks like pre-charting, care planning, documentation, ordering, and more. At Avo, we improve quality of care with love, not alerts. Contact Us