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Appl Clin Inform 2020; 11(05): 714-724
DOI: 10.1055/s-0040-1717084
Research Article

Development of a Taxonomy for Medication-Related Patient Safety Events Related to Health Information Technology in Pediatrics

Kirk D. Wyatt
1   Division of Pediatric Hematology/Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Tyler J. Benning
2   Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Timothy I. Morgenthaler
3   Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Grace M. Arteaga
4   Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Background Although electronic health records (EHRs) are designed to improve patient safety, they have been associated with serious patient harm. An agreed-upon and standard taxonomy for classifying health information technology (HIT) related patient safety events does not exist.

Objectives We aimed to develop and evaluate a taxonomy for medication-related patient safety events associated with HIT and validate it using a set of events involving pediatric patients.

Methods We performed a literature search to identify existing classifications for HIT-related safety events, which were assessed using real-world pediatric medication-related patient safety events extracted from two sources: patient safety event reporting system (ERS) reports and information technology help desk (HD) tickets. A team of clinical and patient safety experts used iterative tests of change and consensus building to converge on a single taxonomy. The final devised taxonomy was applied to pediatric medication-related events assess its characteristics, including interrater reliability and agreement.

Results Literature review identified four existing classifications for HIT-related patient safety events, and one was iteratively adapted to converge on a singular taxonomy. Safety events relating to usability accounted for a greater proportion of ERS reports, compared with HD tickets (37 vs. 20%, p = 0.022). Conversely, events pertaining to incorrect configuration accounted for a greater proportion of HD tickets, compared with ERS reports (63 vs. 8%, p < 0.01). Interrater agreement (%) and reliability (kappa) were 87.8% and 0.688 for ERS reports and 73.6% and 0.556 for HD tickets, respectively.

Discussion A standardized taxonomy for medication-related patient safety events related to HIT is presented. The taxonomy was validated using pediatric events. Further evaluation can assess whether the taxonomy is suitable for nonmedication-related events and those occurring in other patient populations.

Conclusion Wider application of standardized taxonomies will allow for peer benchmarking and facilitate collaborative interinstitutional patient safety improvement efforts.

Keywords

patient safety - patient harm - safety management - electronic health records - medical informatics

Protection of Human and Animal Subjects

This project was reviewed by the Mayo Clinic Institutional Review Board and classified as quality improvement.


Supplementary Material



Publication History

Received: 29 June 2020

Accepted: 21 August 2020

Article published online:
28 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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