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Ambulatory Pediatric Patient Safety Learning Lab: Pursuing Safe Healthcare at Home

Principal Investigator: Kathleen Elizabeth Walsh, M.D., M.S., Boston Children’s Hospital, Boston, MA 
Co-PI: Eric Kirkendall, M.B.I., M.D., Wake Forest School of Medicine, Winston-Salem, NC 
AHRQ Grant No.: HS26644
Project Period: 09/30/18-09/29/23
Description: The overarching goal of this research was to reduce medication errors and treatment delays for children with two types of chronic conditions: type 1 diabetes (T1D) and autism spectrum disorder (ASD).

The specific aims were to:

  1. Redesign processes for adjustment of medication dosing based on clinical information gathered by the patient/family to prevent medication errors. (This process was studied in children with T1D.)
  2. Create patient/family medication monitoring processes and communication with the clinic to prevent adverse drug events. (This process was studied in children with ASD on antipsychotics.)
  3. Design a workflow to plan for, detect, and promptly manage serious illness among children with chronic conditions at home. (This process was studied in both populations.)

The lab comprised a transdisciplinary team of parents, safety researchers, and physicians. The team process mapped data collected from in-home medication review, medication administration observation, parent surveys, simulations, and failure modes and effects analysis (FMEA) to design interventions. Researchers found that patient and family knowledge and skillsets in dealing with these conditions varied considerably. 

For example, more than half of the T1D patients involved in home visits had medication errors, at a rate of 31 per 100 medications. For the ASD cohort, parents had difficulty distinguishing between the adverse effects of medications and behavioral variations/escalations associated with ASD. This challenge led researchers to design, develop, implement, and evaluate personalized care and communication approaches for each cohort.1,2

For the T1D cohort, web-based homecare guidelines, a ketone calculator with instructions, and a “chatbox” dialogue were developed for parents to use when their children were ill. In addition, simulation scenarios were designed to create an entire framework for assessing parents’ knowledge and the safety of their current processes. This framework provided researchers with an evaluation tool and opportunities for patients and parents to improve their understanding. The framework is being incorporated into the routine educational programs at Cincinnati Children’s Hospital and can be further built upon and disseminated via conferences, articles, and electronic resources and tools.1,3,4

For the ASD cohort, researchers developed written and visual support tailored to giving a child with ASD different formulations of medication (i.e., pill, capsule, liquid, or orally disintegrating tablet). The intervention included physicians’ establishing a personalized communication plan with patients/families via phone or patient portal within a certain period (e.g., 2 weeks from visit). If communication delays occurred, the electronic health record (EHR) triggered a message to nurses to enact the communication plan. Early analysis of the project showed a threefold increase in closed-loop communication, from 20 percent contact within 1 month to 60 percent after the implementation and iteration of the program.1,4

To date, this PSLL’s work has resulted in at least five peer-reviewed journal publications that have been cited 55 times in other publications, along with four presentations at conferences during the project period.

Publications

2024

2023

2022

2021

  • Kirkendall ES, et al. Redesigning communication and care for children with type 1 diabetes or autism spectrum disorder and their families. HE8: Patient Population and Patient-Caregiver Experience. Online, 2021.
  • Nelson H, et al. Ambulatory Patient Safety Learning Lab: Failure Modes and Effects Analysis for Management of Type 1 Diabetes During Illness. Poster session, International Society for Pediatric and Adolescent Diabetes (ISPAD) Annual Conference. Online, October 2021. 

2019

References

  1. Walsh, KE. Final Report: Ambulatory Pediatric Patient Safety Learning Lab: Pursuing Safe Healthcare at Home. Cincinnati, OH: Cincinnati Children’s Hospital Medical Center; 2023, pp. 1-20.
  2. Kirkendall et al. Safer type 1 diabetes care at home: SEIPS-based process mapping with parents and clinicians. Pediatr Qual Saf 2023 May/June;8(3):e649.
  3. Brady PW, et al. Promoting action on diagnostic safety: the Safer Dx Checklist. Jt Comm J Qual Patient Saf 2022;48(11):559-560.
  4. Brady PW, et al. Assessing the Revised Safer Dx Instrument® in the understanding of ambulatory system design changes for type 1 diabetes and autism spectrum disorder in pediatrics. Diagnosis (Berl) 2024 Mar 25;11(3):266-272.
Page last reviewed January 2025
Page originally created January 2025

Internet Citation: Ambulatory Pediatric Patient Safety Learning Lab: Pursuing Safe Healthcare at Home. Content last reviewed January 2025. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/patient-safety/resources/learning-lab/ambulatory-pediatric-long-desc.html

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