Little work has been done to address issues around safety in pediatric outpatient care. For example, the safety of many medications has not been tested for children. An area of particular concern is the growing use of pharmaceuticals for mental health conditions in children. Psychoactive drugs often are administered by nurses or unlicensed administrative staff in schools and day care programs. These individuals usually have no training or knowledge of these medications.
To correct such oversights, the MassGeneral Hospital for Children Center for Child and Adolescent Health Policy organized a conference in May 2003 to open a dialogue about these issues and to develop a research agenda to promote safety in outpatient child and adolescent health care. The conference, which was supported in part by the Agency for Healthcare Research and Quality (HS13883), provided compelling information about the need to treat children differently with respect to a number of medication issues. For example, conference participants discussed the importance of weight-based dosing and the need to interact with community providers, especially schools.
Participants also noted safety issues beyond medications. For example, there is little work on medical devices and their safety in children. Also addressed was the central role of parents in managing children's medications and other treatments.
Five themes emerged during the conference. First, communication lapses—for example, between doctors and families or between primary care physicians and specialists—contribute to errors in child and adolescent health care. Second, technological solutions to safety problems, although appealing, may present new risks to pediatric safety. Third, doctors must convince community physicians, hospital managers, and policymakers that medical safety is a problem needing attention. Fourth, high priority must be given to studying effective approaches to enhancing safety. Finally, conference participants emphasized the importance of setting priorities to advance child health care safety.
Details are in "Promoting safety in child and adolescent health care: Conference overview," by James M. Perrin, M.D., and Sheila R. Bloom, M.S. in the January 2003 Ambulatory Pediatrics 4(1), pp. 43-46.
Editor's Note: A background paper, coauthored by Helen R. Burstin, M.D., director of AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships, was prepared for the conference. The authors outline a research agenda for outpatient pediatric safety. For details, see Miller, M.R., Pronovost, P.J., and Burstin, H.R. (2004, January). "Pediatric patient safety in the ambulatory setting." Ambulatory Pediatrics 4(1), pp. 47-54.
Reprints (AHRQ Publication No. 04-R031) are available from the AHRQ Publications Clearinghouse.
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