SafetyDog

Can we honesty say we are doing enough to keep our children safe from harm?

In Patient Safety on December 16, 2012 at 10:41 pm

President Obama uttered these words in his speech to the citizens of Newtown after the tragedy at Sandy Hook elementary.

Those of us in healthcare should ask the same question: Can we honesty say we are doing enough to keep our children safe from harm?

Facts:
School systems continue to layoff professional nurses and untrained school personel are managing medications http://www.philly.com/philly/blogs/healthcare/Denursifying_of_Phila_public_schools_puts_children_at_added_risk_of_medication_errors.html

Studies show children are at risk for safety events in hospitals
“PSI (patient safety indicators) events occurred more frequently in the very young and those on Medicaid insurance, some of the most vulnerable hospitalized children. Regression analysis found that almost all PSIs are associated with significant and substantial increases in length of stay, charges, and in-hospital death. Using the estimates derived here and the actual number of cases identified in the 2000 data, we estimate that patient safety events incurred >$1 billion in excess charges for children alone in 2000.”

Miller, Elixhauser, and Zhan (2003) conducted a review of potential pediatric safety issues by using the previously defined adult indicators. They found that hospitalized children who experienced a patient safety incident, compared with those who did not, had
Length of stay 2- to 6-fold longer
Hospital mortality 2- to 18-fold greater
Hospital charges 2- to 20-fold higher

Slonim and colleagues (2003) found almost 2-3 medical errors per 100 discharges of hospitalized children

Why are children more vulnerable (Excerpt Beal, 2004)?
Development: As children mature both cognitively and physically, their needs as consumers of health care goods and services change. Therefore, planning a unified approach to pediatric safety and quality is affected by the fluid nature of childhood development.
Dependency: Hospitalized children, especially those who are very young and/or nonverbal, are dependent on caregivers, parents, or other surrogates to convey key information associated with patient encounters. Even when children can accurately express their needs, they are unlikely to receive the same acknowledgment accorded adult patients. In addition, because children are dependent on their caregivers, their care must be approved by parents or surrogates during all encounters.
Different epidemiology: Most hospitalized children require acute episodic care, not care for chronic conditions as with adult patients. Planning safety and quality initiatives within a framework of “wellness, interrupted by acute conditions or exacerbations,” presents distinct challenges and requires a new way of thinking.
Demographics: Children are more likely than other groups to live in poverty and experience racial and ethnic disparities in health care. Children are more dependent on public insurance, such as State Children’s Health Insurance Program (SCHIP) and Medicaid.

There are regional pediatric safety collaboratives trying to protect our nation’s children from harm but we need a national coordinated effort. When it comes to children’s safety, there should be no competition only collaboration. Richard Brilli, chief medical officer at Nationwide Children’s Hospital in Columbus, Ohio, said there’s just one acceptable course of action: Commit to eliminating medical errors and harmful practices altogether:”I couldn’t look a family in the eye and say we aspire to be 50 percent better.” (Sternberg, US News, 2010)

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