Britt-Marie Ygge

Validation of triggers and development of a pediatric trigger tool to identify adverse events

BackgroundLittle is known about adverse events (AEs) in pediatric patients. Record review is a common methodology for identifying AEs, but in pediatrics the record review tools generally have limited focus. The aim of the present study was to develop a broadly applicable record review tool to identify AEs in pediatric inpatients.MethodsUsing a broad literature review and expert opinion with a modified Delphi process, a pediatric trigger tool with 88 triggers, definitions, and descriptions including AE preventability decision support was developed and tested in a random sample of 600 hospitalized pediatric patients admitted in 2010 to a single university children’s hospital. Four registered nurse-physician teams performed complete two-stage retrospective reviews of 150 records each from either neonatal, surgical/orthopedic, medicine, or emergency medicine units.ResultsRegistered nurse review identified 296 of 600 records with triggers indicating potential AEs. Records (n = 121) with only false positive triggers not indicating any potential AEs were not forwarded to the next review stage. On subsequent physician review, 204 (34.0%) of patients were found to have had 563 AEs, range 1–27 AEs/patient. A total of 442 preventable AEs were found in 161 patients (26.8%), range 1–22. Overall, triggers were found 3,598 times in 417 (69.5%) records, with a mean of 6 (median 1, range 0–176) triggers per patient. The overall positive predictive value of the triggers was 22.9%, (range 0.0-100.0%). The final pediatric trigger tool, developed with a second Delphi round, required 29 triggers.ConclusionsAEs are common in pediatric patients and most are preventable. The main contributions of this study are to further develop and adapt trigger definitions, including AE preventability decision support, to introduce new triggers in pediatric care, as well as to apply pediatric triggers in different clinical specialties. Our findings resulted in a national pediatric trigger tool, and might also be adapted internationally. The pediatric trigger tool can help healthcare organizations to measure and analyze the AEs occurring in hospitalized children in order to improve patient safety.

Experiences of young adults growing up with innate or early acquired HIV infection--a qualitative study

AIM To explore the experience of young adults growing up and living with HIV in urban Sweden. BACKGROUND HIV has become a widespread pandemic. Effective antiretroviral treatment has dramatically increased the survival rate of infected individuals, such that HIV infection is currently considered a chronic disease where treatment is available. Data concerning the experience of living with HIV since early childhood is scarce and more empirical knowledge is needed to direct the development of adequate care and interventions for this growing demographic. DESIGN Exploratory qualitative study. METHOD Semi-structured interviews were conducted with ten HIV-infected young adults over the period from January-August 2008. Transcripts of the interviews were analysed using qualitative content analysis. FINDINGS The analysis revealed five categories illustrating the experiences of growing up and living with HIV in Sweden: (1) to protect oneself from the risk of being stigmatized; (2) to be in control; (3) losses in life, but HIV is not a big deal; (4) health care/healthcare providers; and (5) belief in the future. CONCLUSION It is essential to offer a safe, trustworthy, and professional healthcare environment during the upbringing of HIV-infected children. Evidence-based interventions are needed to improve care and support, particularly about the handling of stigma and discrimination.

Peripheral venous catheter related complications are common among paediatric and neonatal patients.

The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC‐related complications.

Accuracy in documentation of peripheral venous catheters in paediatric care: an intervention study in electronic patient records

AIMS The aim of this study is to compare the accuracy and completeness in the recording of peripheral venous catheters before and after implementing a template in the electronic patient record in paediatric care. BACKGROUND As a basis for quality improvement and research purposes and to ensure patient safety, accurate clinical data need to be easily accessible in patient records. Several studies have concluded that the relation between performed care and what is documented in patient records is poor. DESIGN Before and after study. METHOD The study took place at a large paediatric university hospital in Sweden. Inclusion criteria were patients who were admitted to one of the included wards, had one or several peripheral venous catheters and were available at the ward at the time for data collection. Data were collected by observations and record audits before and then four and 10 months after the introduction of a template for recording peripheral venous catheters in a structured and standardised way. RESULTS A significant increase in peripheral venous catheters with complete recording was observed after as compared with before the intervention. The percentage of peripheral venous catheters with recording of any kind was relatively stable (85-93%). The overall recording of peripheral venous catheters insertion did not improve, but there was an increase in the recording of side and size after the intervention. One of the 22 complications observed before the intervention was documented and none of the complications (n = 17 and n = 9) after. CONCLUSION The electronic patient record did not provide accurate data on peripheral venous catheters in paediatric care neither before nor after the intervention. RELEVANCE TO CLINICAL PRACTICE Further efforts to increase the documentation of catheter-related complications are needed. Integrated decision support systems in electronic patient records that remind nurses to inspect peripheral venous catheters regularly could be one solution.

HIV-related stigma and health-related quality of life among children living with HIV in Sweden

ABSTRACT The relationship between HIV-related stigma and health-related quality of life (HRQoL) among children living with HIV infection is unknown. The objectives of this study were to describe HIV-related stigma and HRQoL among children with perinatal HIV living in Sweden, and to investigate the relationship between these two factors in the same infection group. In a cross-sectional nationwide survey, HIV-related stigma was measured with the 8-item HIV Stigma Scale for Children. HRQoL was measured with the 37-item DISABKIDS Chronic Generic Module. Structural equation modeling was used to explore the relationship between HIV-related stigma and HRQoL. Fifty-eight children participated, age 9–18 years (mean = 13.9). The HIV stigma general scale showed a mean score of 17.6 (SD = 5.0; possible range 8–32). DISABKIDS Chronic Generic Module general scale showed a mean score of 80.7 (SD = 14.1; possible range 0–100). HIV-related stigma was negatively associated with HRQoL (standardized β = −0.790, p = .017). The results indicate that childrens concerns related to disclosure of their HIV infection seem to be common (i.e. 75% agreed) which, together with the negative association between ratings of HIV-relatively stigma and HRQoL, might indicate that disclosure concerns would be a relevant target for interventions to decrease HIV-related stigma and increase HRQoL.

Accuracy in documentation of pheripheral venous catheters in paediatric care : An intervention study in electronic patient records

AIMS The aim of this study is to compare the accuracy and completeness in the recording of peripheral venous catheters before and after implementing a template in the electronic patient record in paediatric care. BACKGROUND As a basis for quality improvement and research purposes and to ensure patient safety, accurate clinical data need to be easily accessible in patient records. Several studies have concluded that the relation between performed care and what is documented in patient records is poor. DESIGN Before and after study. METHOD The study took place at a large paediatric university hospital in Sweden. Inclusion criteria were patients who were admitted to one of the included wards, had one or several peripheral venous catheters and were available at the ward at the time for data collection. Data were collected by observations and record audits before and then four and 10 months after the introduction of a template for recording peripheral venous catheters in a structured and standardised way. RESULTS A significant increase in peripheral venous catheters with complete recording was observed after as compared with before the intervention. The percentage of peripheral venous catheters with recording of any kind was relatively stable (85-93%). The overall recording of peripheral venous catheters insertion did not improve, but there was an increase in the recording of side and size after the intervention. One of the 22 complications observed before the intervention was documented and none of the complications (n = 17 and n = 9) after. CONCLUSION The electronic patient record did not provide accurate data on peripheral venous catheters in paediatric care neither before nor after the intervention. RELEVANCE TO CLINICAL PRACTICE Further efforts to increase the documentation of catheter-related complications are needed. Integrated decision support systems in electronic patient records that remind nurses to inspect peripheral venous catheters regularly could be one solution.

Retrospective study showed that blood sampling errors risked children's well-being and safety in a Swedish paediatric tertiary care

Blood analyses containing preanalytical errors (PAEs) are hazardous for patients. This study investigated the frequency of PAEs in blood analysis and the corresponding quality indicators of the sampling process in Swedish paediatric tertiary care.

Legal guardians understand how children with the human immunodeficiency virus perceive quality of life and stigma

This aim of this study was to describe how legal guardians assessed health‐related quality of life and HIV‐related stigma in children with the human immunodeficiency virus (HIV) compared to the childrens own ratings.