Inter- and intra-rater reliability for classification of medication related events in paediatric inpatients.
TLDR
Trained reviewers can reliably assess paediatric inpatient medication related events for the presence of an ADE and for its seriousness and preventability, according to a decision algorithm and six point scale.Abstract:
Background: In medication safety research studies medication related events are often classified by type, seriousness, and degree of preventability, but there is currently no universally reliable “gold standard” approach. The reliability (reproducibility) of this process is important as the targeting of prevention strategies is often based on specific categories of event. The aim of this study was to determine the reliability of reviewer judgements regarding classification of paediatric inpatient medication related events.
Methods: Three health professionals independently reviewed suspected medication related events and classified them by type (adverse drug event (ADE), potential ADE, medication error, rule violation, or other event). ADEs and potential ADEs were then rated according to seriousness of patient injury using a seven point scale and preventability using a decision algorithm and a six point scale. Inter- and intra-rater reliabilities were calculated using the kappa (κ) statistic.
Results: Agreement between all three reviewers regarding event type ranged from “slight” for potential ADEs (κ = 0.20, 95% CI 0.00 to 0.40) to “substantial” agreement for the presence of an ADE (κ = 0.73, 95% CI 0.69 to 0.77). Agreement ranged from “slight” (κ = 0.06, 95% CI 0.02 to 0.10) to “fair” (κ = 0.34, 95% CI 0.30 to 0.38) for seriousness classifications but, by collapsing the seven categories into serious versus not serious, “moderate” agreement was found (κ = 0.50, 95% CI 0.46 to 0.54). For preventability decision, overall agreement was “fair” (κ = 0.37, 95% CI 0.33 to 0.41) but “moderate” for not preventable events (κ = 0.47, 95% CI 0.43 to 0.51).
Conclusion: Trained reviewers can reliably assess paediatric inpatient medication related events for the presence of an ADE and for its seriousness. Assessments of preventability appeared to be a more difficult judgement in children and approaches that improve reliability would be useful.read more
Citations
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Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital
Ali Baba-Akbari Sari,Trevor A Sheldon,Alison Cracknell,Alastair Turnbull,Yvonne Dobson,Celia Grant,William Gray,Aileen Richardson +7 more
TL;DR: It is confirmed that adverse events are common, serious and potentially preventable source of harm to patients in NHS hospitals and the accuracy and reliability of a structured two-stage casenote review in identifying adverse events in the UK was confirmed.
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Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study
Anne Matlow,G. Ross Baker,Virginia Flintoft,D. Douglas Cochrane,Maitreya Coffey,Eyal Cohen,Catherine M.G. Cronin,Rita Damignani,Robert Dubé,Roger Galbraith,Dawn Hartfield,Leigh Anne Newhook,Cheri Nijssen-Jordan +12 more
TL;DR: There are many opportunities to reduce harm affecting children in hospital in Canada, particularly related to surgery, intensive care and diagnostic error, but adverse events in the former are less likely to be preventable.
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Incidence, preventability, and impact of Adverse Drug Events (ADEs) and potential ADEs in hospitalized children in New Zealand: a prospective observational cohort study.
TL;DR: ADEs represent a considerable hazard for the pediatric inpatient population and ADEs represent a large cost imposition upon the healthcare sector, highlighting the importance of developing strategies to prevent and ameliorate ADEs.
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NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit
Theodora A. Stavroudis,Andrew D. Shore,Laura L. Morlock,Rodney W. Hicks,David G. Bundy,Marlene R. Miller,Marlene R. Miller +6 more
TL;DR: Risk factors for harmful medication error reports include use of ISMP High-Alert Medications, the prescribing phase of the medication use process, and failure of equipment/delivery devices.
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The inter-rater agreement of retrospective assessments of adverse events does not improve with two reviewers per patient record
Marieke Zegers,Martine C. de Bruijne,Cordula Wagner,Peter P. Groenewegen,Gerrit van der Wal,Henrica C.W. de Vet +5 more
TL;DR: A record review process with two physicians per record including a consensus procedure to assess AEs is not more reliable than a record reviewprocess with one physician.
References
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Book
Basic and Clinical Biostatistics
TL;DR: Here is absolutely everything medical students need to know about biostatistics and quantitative methods as applied to medicine, clinical practice, and research.
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