Pediatric Informatics: Computer Applications in Child Health (Health ...

76 M.A. Del Beccaro et al.
� Duplicate and conflicting orders:
Medication reconciliation to avoid
duplication should occur when a patient is transferred between care units.
However, duplicate medication orders may also occur when an order is
changed, or if there are different orders for different contingencies (such as
two orders for acetaminophen: one for fever and one for pain). Such scenarios
allow for overdosing. In the ICU, depending on the CPOE system,
titrations of continuous infusions may pose similar problems (Changing an
infusion rate may mean discontinuing the first rate, followed by ordering the
new rate). Standards for addressing these issues are in development.
It’s about culture change:
The biggest factor that contributes to success with
CPOE is the recognition that HIT adoption is cultural change. With strong leadership,
all of Seattle Children’s was involved in the design, build, implementation,
and post “go-live” support of the system after months of preparation and
universal training on the system. The driving force of patient safety requires
institutional “buy in” as the fundamental first step.
7.6 Areas of Research and Development
Progress in invasive and noninvasive monitoring of patients provides opportunities
and challenges for ED/critical care information systems to incorporate new
data into decision support tools. Outcome prediction models based on noninvasive
monitoring 47 may allow real time decision making in trauma. Trigger tools 48,49 may
help in identifying and averting errors in critical care. Patterns such as heart rate
variability may help predict sepsis in critically ill children and infants. 50
Communication handoffs are another area of investigation to improve safety in
critical care. An understanding of the daily care plan goals by all team members
is an essential component to the management of complex, critically ill patients. 51
Clinical information systems should provide the centralized repository of these
daily goals as document that changes as the patient’s conditions change and serves
as the basis for care decisions. However, the adoption of this form of technology,
does not eliminate the need for face to face communication, and in fact may
increase it, in order to provide the necessary context. 52
7.7 Conclusion
The challenges of PEM and PCC pose new opportunities for the application of
information technology and systems design to better handle critically ill children
in all types of situations, outside and within the hospital. The ability of technology
to extend pediatric-specific emergency care into remote areas and to reduce errors
within hospitals will improve outcomes.