2,8 As reported in an earlier study, ADE rates in hospitalized children were substantially higher (15.7 per 1000 patient-days) than previously described.9 However, 22% of all ADEs could be preventable, and 17.8% could have been identified earlier.9
In 2001, the ISMP and the Pediatric Pharmacy Advocacy Group (PPAG) collaborated to produce the nation’s first set of guidelines to reduce pediatric medication errors.10 The American Academy of Pediatrics (AAP) has also taken a lead in making recommendations to reduce errors.11 
Closure of performance gaps and “getting to zero” medication errors will require the constant vigilance from all healthcare professionals and the commitment of hospitals and healthcare systems to implement action in the form of specific leadership, practice and technology plans. This will lead to a decrease in medication errors and a reduction in the occurrence of preventable ADEs in pediatric patients.

Leadership Plan

The hospital board, executives and other senior administrative leadership (medicine, pharmacy and nursing) must fully understand the performance gaps in reducing pADEs at their own healthcare systems. Commitment from all the leaders and stakeholders is necessary for the successful closure of these performance gaps. Leaders should endorse a comprehensive pADE reduction action plan and ensure implementation across all providers and systems. Strategic and tactical approaches that hospital leadership should endorse include the following:

Practice Plan

Technology Plan

Suggested practices and technologies are limited to those proven to show benefit or are the only known technologies with  a  particular  capability.  As  other  options  may  exist,  please  send information  on  any  additional  technologies, along with appropriate evidence, to info@patientsafetymovement.org.
Technology has  significantly  advanced  in  the  last  decade  within  the  healthcare  setting  with  development  of Electronic Health Records (EHR), CPOE, barcode medication administration (BCMA), bar code assisted medication preparation system (BCMP) and smart pump infusion technology. Multiple studies in pediatrics have demonstrated a decrease   in   both   prescribing   errors   and   ADEs   after   implementing   these   technologies.12,24,42,43,44,45,46,47,48,49,50However, most of these systems are designed for use in adult patients and customization is often needed to  ensure optimal use in pediatric patients.31,51

Essential Criteria to Consider

The system must be:
  1. Capable of capturing 100% of all hand hygiene events (soap and sanitizer) electronically in real-time.
  2. Capable of reporting Hand Hygiene Compliance (HHC) based on the WHO 5 Moments for Hand Hygiene  at the Group, Unit, Ward or Department Level.\cite{Steed_2011}
  3. Validated for accuracy in at least one peer reviewed study.\cite{Diller_2014}
  4. Supported by scientific evidence of efficacy.
  5. Supported with a behavior and culture change tool kit.
Consider an Electronic Monitoring System for Hand Hygiene Compliance to ensure an accurate and reliable data set from which real improvement can be driven, such as:

Metrics

Topic

Observed Hand Hygiene Compliance

Compliance rate of hand hygiene by observation

Outcome Measure Formula

Based on the “My five moments for hand hygiene” method.\cite{Sax_2007,Sax_2009} Moments defined as:
  1. Before patient contact,
  2. Before aseptic task,
  3. After body fluid exposure,
  4. After patient contact and
  5. After contacts with patient surroundings.
The formula can be used to calculate hand hygiene compliance during all 5 moments. Moments 1 and 4, before and after patient contact are key calculations.
Numerator: Number of hand hygiene actions performed
Denominator: Number of hand hygiene actions required (hand hygiene opportunities)
*Rate is typically displayed as Events/10,000 Adjusted Patient Days

Metric Recommendations

Direct Impact: All Patients
Lives Spared Harm:
\(Lives\ =\ \left(Compliance\ Rate_{measurement}\ -\ Compliance\ Rate_{baseline}\right)\ x\ Healthcare-associated\ Infection\ Rate\ _{baseline}\)
Data Collection:  Direct observation of hand hygiene practices in identified clinical settings with one (or two) trained and validated observers. Observers will watch healthcare workers’ hand hygiene practices at the point-of-care. The observer openly conducts observations but the identities of the healthcare workers are confidential. Based on WHO Guidelines on Hand Hygiene in Healthcare (2009) and “Save lives, Clean Your Hands” campaign.(World Health Organization 2009)