Reducing adverse events among children in Canadian Hospitals
As a caring mother and nurse, Sabina Robin is a tireless advocate when it comes to making healthcare safer for hospitalized children. Sabina lost her seven-month old daughter, Mataya, as a result of an adverse event while in hospital. “Children often cannot speak for themselves and their safety needs to be a priority in all healthcare settings,” says Robin. “It all comes down to teamwork and communication, while respecting the input of the loved ones involved in the child’s care.”
Over nine per cent of children admitted to hospitals in Canada experience harm that can lead to death, disability, prolonged hospital stay, or readmission. The Canadian Paediatric Adverse Events Study, the first national study on adverse events in hospitalized children, identifies areas to focus efforts that can reduce harm and make paediatric healthcare safer.
Dr. Anne Matlow, lead Researcher for the study and former Medical Director of Patient Safety at The Hospital for Sick Children (SickKids) says the results signal a wake-up call to the issue of adverse events in hospitalized children and presents an opportunity for paediatric and community health centres to better understand what is happening in their own facilities.
“While there is a greater focus to make paediatric care safer and a lot of work has already begun, there are a number of issues that still need to be addressed such as ensuring appropriate staffing, tools and resources; up-to-date guidelines; and standardized equipment,” says Dr. Matlow. “This report flags some of the high risk areas for healthcare facilities, what to focus on and where to direct their quality improvement efforts.”
The study results are based on examining 3,669 medical charts from 22 hospitals in seven provinces across Canada. Charts for patients admitted from April 2008 through March 2009 were reviewed using the Canadian Association of Paediatric Health Centres (CAPHC) Paediatric Trigger Tool (CPTT); the analysis was evenly distributed across four age groups (0 to 28 days; 29 to 365 days; one to five years; and six to 18 years of age).
Elaine Orrbine, President and CEO of CAPHC says that although most adverse events are unintentional and that we have one of the safest and best healthcare systems, we can learn from the study results to improve the standard and quality of care.
“Medication errors make up about 50 per cent of all adverse events. Much work is being done to improve how we administer high risk medications to children,” says Orrbine. “Through collaboration and working together to establish national standards and guidelines that can be implemented system-wide, we can address these adverse event challenges.”
The Canadian Paediatric Adverse Events Study found that there were almost three times as many adverse events occurring in academic hospitals (11.2 per cent) than in community hospitals (3.3 per cent). Academic hospitals tend to care for a broader population of paediatric patients, many of whom have complex medical conditions and needs, which may explain this variation. Academic hospitals also perform more surgeries and more complicated procedures than community hospitals.
The study recommends that overall opportunities to reduce harm should focus on surgical safety, intensive care and diagnostic error; although each organization should also identify what their specific challenges to patient safety are and prioritize accordingly. Neonates needing intensive care (ICU) for at least a day were 10 times as likely to have an adverse event compared to those not requiring ICU care. Surgical patients over 28 days of age were twice as likely to have an adverse event, compared to their medical counterparts. While diagnostic adverse events are common and usually preventable, the study found children over the age of one were the most vulnerable. In community hospitals, more focus on emergency room care for toddlers and maternal/obstetrical care is required.
The Canadian Paediatric Adverse Events Study (CPAES) was funded in part by the Canadian Patient Safety Institute, The Hospital for Sick Children, and other academic paediatric health centres across the country. Thanks to The Canadian Association of Paediatric Health Centres for their support and commitment in developing the CPTT and for their ongoing dedication to the safety and health of Canadian children, www.caphc.org/patient-safety/.
For more information on CPAES and other research studies, visit www.patientsafetyinstitute.ca. To view a short video on Sabina Robin’s story visit www.YouTube.com/patientsafetycanada.