Pediatric Adverse Event Risk Reduction for High Risk Medications in Children and Adolescents: Improving Pediatric Patient Safety in Dental Practices

降低儿童和青少年高风险药物的儿科不良事件风险：提高牙科诊所中儿科患者的安全

• 批准号: 10440970
• 负责人: KJ Suda
• 金额: $ 79.35万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-04 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440970
• 关键词: Adolescent; Adult; Adverse event; Age; American; Anesthesia procedures; Anti-Anxiety Agents; Attitude; Benzodiazepines; Caring; Case Study; Cessation of life; Child; Child Health; Childhood; Chronic; Clinical; Clinical Trials; Communities; Conscious Sedation; Data; Decision Making; Dental; Dental Care; Dental Care for Children; Dental General Practice; Dental caries; Dentistry; Dentists; Development; Disease; Drug Prescriptions; Emergency Care; Ensure; Evidence based intervention; Evidence based practice; Exposure to; Future; General Anesthesia; General anesthetic drugs; Goals; Harm Reduction; Health; High Prevalence; Hospitalization; Hypoxemia; Incidence; Infection; Inflammation; Intervention; Interview; Knowledge; Measures; Medical; Medical Care Team; Medical Errors; Medical History; Methods; Modeling; National Institute of Child Health and Human Development; Nurse Practitioners; Opioid; Opioid Analgesics; Outcome; Outcome Study; Pain; Pain management; Parents; Patient-Focused Outcomes; Patients; Pattern; Pediatrics; Perception; Pharmaceutical Preparations; Physician Assistants; Physicians; Procedures; Provider; Research; Research Priority; Resources; Risk; Risk Reduction; Safety; Sampling; Sedation procedure; Serious Adverse Event; Standardization; Testing; Tooth Extraction; Training; Ventilatory Depression; Youth; adverse event risk; adverse outcome; airway obstruction; care systems; design; early childhood; effectiveness testing; emerging adult; evidence base; high risk; human error; improved; medication administration; medication safety; mortality; opioid misuse; opioid overdose; opioid use; patient safety; pediatric patients; pilot test; population based; practice setting; prescription opioid; procedure safety; risk perception; routine practice; safety outcomes; safety practice; sociodemographic factors; third molar extraction; trend; urgent care; usability; wisdom tooth

A narrow margin of safety exists in the care of pediatric dental patients, and this often occurs in practice settings with less information on patients’ full medical history that is crucial for the safe practice of dentistry. Although dentists administer and prescribe a limited number of medications in routine practice, many of these medications carry a high risk for human error and complications. High-risk medications are frequently prescribed and administered by dentists to children and have resulted in serious unintended consequences, including adverse events – such as death – during conscious sedation or general anesthesia, and the overprescribing of opioids. More than 100,000 pediatric dental sedations are performed annually in the U.S. The most common medications used for these procedures are benzodiazepines, opioids, and general anesthetics. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction and death. Most Americans have their first exposure to opioids in their youth following third molar extraction. This use of prescription opioids has been associated with an increased risk of opioid misuse into adulthood. These trends in early adulthood and case reports of pediatric deaths occurring following dental sedation procedures make clear the urgency to understand and implement best patient safety practices in the dental care of children. Yet, U.S. data on medication prescribing patterns of pediatric dentists, evidence-based prescribing and community dental providers’ attitudes toward implementation of pediatric patient safety is scarce. Although efforts and resources exist to curtail overprescribing of opioids and best patient safety practices in pediatric sedation, most interventions are focused on physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) and may fail in broader implementation to pediatric dental practices. The objective of this mixed- methods study is to improve high-risk pediatric prescribing patterns among dentists by identifying current prescribing patterns associated with poor health outcomes that could be targeted for intervention. To accomplish this objective we aim to: (1) determine the extent to which high-risk medications are prescribed to pediatric dental patients and rates of poor patient outcomes in a population-based sample of commercially- and publicly-insured children; (2) [Examine] dentists’ attitudes towards medication safety when prescribing high- risk medications and decision-making when prescribing high-risk medications for pediatric patients; and (3) [Develop and pilot a checklist to facilitate treatment decisions that best promotion medication safety in pediatric dental care]. We anticipate this study will close the knowledge gap on dental prescribing patterns of high-risk medications to children, association with poor patient outcomes, and determine dentist perceptions of the safety of these medications. [This mixed-methods study will design and implement an evidence-based intervention to minimize harms from high-risk medications and improve safe dental practice to children and adolescents.]

小儿牙科患者的护理中存在狭窄的安全余地，这通常在实践环境中发生 关于患者的完整病史的信息较少，这对于牙科的安全实践至关重要。虽然 牙医在常规实践中管理并规定了有限数量的药物，其中许多药物 具有人为错误和并发症的高风险。高风险药物经常处方 由牙医管理给儿童，并带来严重的意外后果，包括对手 在有意识的镇静或全身麻醉期间的事件（例如死亡），以及阿片类药物的过度处方。 每年在美国进行100,000多个小儿牙科镇静剂，这是最常见的药物 用于这些程序的是苯二氮卓类药物，阿片类药物和全身麻醉药。所有这些都与认真有关 不良事件，包括低氧血症，呼吸道抑郁，气道阻塞和死亡。大多数美国人 在第三层摩尔提取后，他们的青年时期就首次接触了卵巢菌素。这种处方opioids的使用 与成年后的阿片类药物滥用风险增加有关。这些趋势在成年初期 牙科镇静程序后发生的小儿死亡的病例报告明确表明了 了解并实施儿童牙科护理中的最佳患者安全实践。但是，美国的数据 儿科牙齿，基于证据的处方和社区牙齿的药物处方模式 提供者的参与者稀少。尽管努力和资源 存在于降低阿片类药物和最佳患者安全实践的过度处方，大多数 干预措施的重点是医生和高级执业提供者（即护士从业者和医师 助手），并且可能无法对小儿牙科实践更广泛地实施。这种混合的目的 方法研究是通过识别电流来改善牙医之间的高风险小儿处方模式 开处方与不良健康结果相关的模式，可以针对干预。到 实现我们的目标：（1）确定规定高风险药物的程度 小儿牙科患者和基于人口的商业样本样本中患者的差率 和公共保险的孩子； （2）[检查]牙医的参与者在开处方高处处方时进行药物安全 在为儿科患者开出高风险药物时，有风险药物和决策； （3） [开发并试行一份清单，以促进治疗决策，以最好的促进药物安全性儿科安全性 牙科护理]。我们预计这项研究将缩小有关高风险牙科处方模式的知识差距 儿童的药物，与差的患者结局相关，并确定牙医对安全性的看法 这些药物。 [这项混合方法研究将设计和实施基于证据的干预措施 最大程度地减少高风险药物的危害，并改善儿童和青少年的安全牙科诊所。]