RESUMEN
OBJECTIVES: Smart pump interoperability is a newer technology integrating intravenous medication -infusion instructions from the electronic medical record into a smart pump. This technology has demonstrated significantly decreased medication errors in the adult population; however, this has not been reported in pediatrics. The purpose of this study was to compare the frequency and severity of infusion related errors before and after the implementation of smart pump interoperability at a pediatric institution. METHODS: This was a retrospective study conducted at multiple institutions within the same health care system to assess the effect of smart pump interoperability on infusion errors. Data were retrospectively analyzed for a 6-month period prior to (January-June 2020) and after (January-June 2022) smart pump interoperability implementation. All who received medications via a smart pump were included in the analysis. Infusions were excluded if administered via a patient-controlled analgesia pump, epidural pump, or intravenously pushed without using a smart pump. RESULTS: A total of 143,997 versus 165,343 infusions were administered in the before versus after interoperability group. There were significant decreases in mild, moderate, and severe harm averted events once interoperability was implemented (p < 0.001). Errors caught before administration decreased after interoperability implementation from 197 events to 20 events because of fewer overall errors (p < 0.001). The number of guardrail alert overrides was significantly reduced, from 23,751 to 5885 (p < 0.001), as was the number of high-risk overrides, from 5851 to 207 (p < 0.001). CONCLUSION: Implementing smart pump interoperability significantly reduced the frequency and severity of infusion errors and high-risk overrides at a pediatric institution.
RESUMEN
OBJECTIVES: The Advisory Committee on Immunization Practices (ACIP) recommends additional immunizations for people with asplenia or functional asplenia, such as children with sickle cell disease. Adherence rate to the recommended immunization schedule for functional asplenia remains low for children with sickle cell disease. The purpose of this study was to assess the immunization adherence for this population at a single institution in Kentucky and to evaluate the use of the Kentucky Immunization Registry (KYIR) by providers. METHODS: A single-center retrospective chart review was conducted for 107 children with sickle cell disease ages 2 through 18 years. Immunization histories were obtained from the hospital EMRs, the sickle cell clinic EMR, the KYIR, and by requesting records from primary care physicians. Each patient was documented as either missing or having complete records in the KYIR. RESULTS: The complete adherence rate to the ACIP-recommended immunization schedule for children with functional asplenia was 6% (6 of 107). Nearly all children were compliant with the Haemophilus influenzae type B vaccination, whereas the adherence rate for the meningococcal and pneumococcal vaccines ranged from 25% to 77%. The lowest immunization rate was observed in children eligible for the meningococcal B vaccine (25%). Only 3 patients had a complete immunization history documented in the KYIR. CONCLUSIONS: Adherence to the ACIP-recommended immunization schedule for functionally asplenic patients is poor among children with sickle cell disease included in this study. Quality improvement measures should focus on increasing immunization adherence and improving documentation of immunization records in the KYIR for this patient population.
