Preventing Medication Errors Among Children With Chronic Conditions in Outpatient and Home Settings
Kathleen Walsh, M.D., M.Sc.
Director, Patient Safety Research Core
Boston Children’s Hospital
“AHRQ funding enables researchers to build a body of work that advances healthcare quality and safety.”
Improving pediatric patient safety is a top priority for Kathleen Walsh, M.D., M.Sc., director of the Patient Safety Research Core at Boston Children’s Hospital. With AHRQ funding, Dr. Walsh is working to prevent medication errors and adverse drug events among children, particularly those with chronic conditions.
Medication errors that occur outside the hospital can be lethal for children with chronic conditions, such as heart disease, diabetes, and cancer. One in four children has a chronic condition and one in five takes a daily medication. Children with cancer are at particularly high risk for errors due to weight-based dosing calculations, frequent dose adjustments with liquid medications and/or the need to cut tablets, and complex at-home regimens often involving multiple caregivers administering medication.
To help address this critical problem, Dr. Walsh received a 3-year AHRQ grant in 2015 to identify the factors that contribute to medication error and injury in children with chronic conditions. Her team found that 10 percent of children with leukemia or lymphoma experienced adverse drug events due to outpatient medication errors. In general, failures in communication about changes in medication doses were common, and one in four caregivers reported administering double doses or missing doses due to miscommunication with another caregiver about whether the dose already had been given. Based on her findings, Dr. Walsh concluded that specific improvements were necessary to address communication with and among caregivers and families. She determined that interventions should be based on human-factors engineering, which focuses on how people use systems and technology, and redesign them to optimize safety.
With a continued focus on reducing medication errors in children with chronic conditions, Dr. Walsh was awarded a 5-year AHRQ-funded Patient Safety Learning Laboratory grant in 2018. Her Ambulatory Pediatric Safety Learning Lab focuses on preventing harm in children caused by the outpatient healthcare system, specifically identifying failures and potential solutions associated with medication errors and treatment delays. She aims to redesign systems of care and coordination between the clinic and home to eliminate harm. The project is expected to end in September 2023.
In 2020, Dr. Walsh received another AHRQ grant to test strategies to improve the national adoption of a pediatric intervention to reduce exposure to nephrotoxic medicines, which is common for hospitalized children. Nephrotoxic medicines, such as contrast dye or nonsteroidal anti-inflammatory drugs, can cause acute kidney injury, which increases the risk of mortality, length of hospital stay, and long-term risk of developing chronic kidney disease.
She developed a customized prototype based on the AHRQ-funded Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) program, first implemented more than a decade ago. “After hospitals develop new interventions that improve healthcare quality or patient safety, it can be very difficult to see the same impact when spreading the interventions to other hospitals nationally,” notes Dr. Walsh. Among the strategies that Dr. Walsh and her team are testing is one that adds pharmacists, who are experts in medication management, to the NINJA multidisciplinary implementation team. Her study includes a quality improvement collaborative of more than 135 hospitals. The project will end July 31, 2024.
Dr. Walsh, who also is the director of the Harvard-wide Pediatric Health Services Research Fellowship at Boston Children’s Hospital, began serving as project lead of an AHRQ-funded National Research Service Award (NRSA) institutional training grant in 2021. The NRSA training grant provides support to institutions that offer advanced training to predoctoral and postdoctoral program fellows who are committed to careers in health services research. “Graduates of the program will help to transform the current healthcare system to be more efficient, effective, and patient- and family-centered for all children,” said Dr. Walsh. This 4-year training grant will end June 30, 2023.
Dr. Walsh’s most current AHRQ project, Re-Engineering Patient and Family Communication to Improve Diagnostic Safety Resilience, aims to adapt and test an intervention to improve diagnostic safety for use in the outpatient setting that currently supports communication between clinicians and families of hospitalized children. The 4-year project is scheduled to conclude in September 2026.
As a member of the Solutions for Patient Safety Network, Dr. Walsh received the John M. Eisenberg Award for Innovation in Quality and Safety at the National Level in 2018. The team received the award for its substantial reduction in preventable harm caused by healthcare to hospitalized children nationally. She is an adjunct professor of Pediatrics at the University of Cincinnati. She also is a member of the Academic Pediatric Association, American Academy of Pediatrics, and the Society for Pediatric Research.
Principal Investigator: Kathleen Walsh, M.D., M.Sc.
Institution: Boston Children’s Hospital
Grantee Since: 2015
Type of Grant: Various
Related AHRQ Resources
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