NPSF Research Projects and Principal Investigators

2009–2010 Grant Cycle

James S. Todd Memorial Research Award:
Improving Hospital Safety for Children: Strategies to Engage Parents in Bedside Rounds
Elizabeth Cox, MD, PhD, University of Wisconsin School of Medicine and Public Health

This research seeks to improve hospitalized pediatric patients' safety by identifying strategies to support family members' engagement in their care. Pediatric patients are especially vulnerable to medical error, in part because they are not fully capable of employing the communication techniques recommended to reduce errors. Family engagement is advocated as essential to ensuring children's safety during hospitalizations; however, engaging families in care to improve safety has met with reluctance from both healthcare team (HCT) members and families. To facilitate family engagement, experts recommend conducting rounds in patients' rooms with family present. This research will identify strategies that address barriers and facilitators of family engagement during bedside rounds (BR) in a children's hospital.

Data will consist of ~72 videos of BR for 30 enrolled families from the hospital's inpatient units. Two key systems engineering approaches will be used to identify strategies with high likelihood of success. First, stimulated recall will be used to elicit end users' (families' and HCT members') input in identifying barriers and facilitators of family engagement and generating strategies to directly address these. Second, a work systems framework will be used to ensure recognition of barriers and facilitators arising throughout the healthcare system. To the investigators' knowledge, this work will be the first rigorous attempt to understand how to engage families specifically to improve safety. Future work outside the scope of this proposal will subject these strategies to evaluation and prioritization by stakeholders before 1) incorporating them into the institution's planned interventions for families and the HCT and 2) evaluating the interventions' impact on safety for hospitalized children.

NPSF Board Grant:
Analysis of CPOE-related errors reported to USP's MEDMARX error reporting system
Gordon Schiff, MD, Brigham and Women's Hospital/ Harvard Medical School

Computerized Prescriber Order Entry (CPOE) has been demonstrated to be one of the high leverage interventions for decreasing medication errors. At the same time, there are well documented reports and growing concerns that CPOE can actually introduce or facilitate new errors. USP's MEDMARX system is a pioneering medication error reporting system that has collected more than 1.5 million medication error reports since 1999, and in 2003 added a coded field for reporters to indicate CPOE as a contributing cause of the error.

This project will analyze 53,367 medication errors reported to the USP MEDMARX error reporting system where "Computerized Prescriber Order Entry" was checked off by the reporter as a contributing cause of the error. Descriptive statistics will be performed to analyze the drugs and drug classes involved, dosing issues, location in the drug use process (i.e. prescribing, dispensing), outcomes (severity classification), and other contributing factors identified by the reporters. In-depth review of the report narratives will be conducted to extract insights into the nature and mechanism of the reported CPOE-related errors. Based on this analysis, a new taxonomy for CPOE-related errors and process failure modes will be created and tested. In addition, the investigators will test the vulnerability of leading CPOE systems (Partners LMR, Epic, E-Clinical Works, and the VA VISTA system) to these actual errors reported to MEDMARX by attempting to replicate (on test patients) these reported errors, examining these leading systems' susceptibility to (or ability to prevent) these errors. Finally, the investigators will draw upon lessons learned to make recommendations for safer CPOE use and design the local and national levels. This will include specific feedback on the results of the vulnerability testing findings to the individual institutions and CPOE systems (vendor and home locally developed). These lessons and findings will be cross-referenced and correlated with other research on CPOE-related errors.