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Leapfrog CPOE Simulator Still Flawed
July 11, 2010

Posted by chcablogadmin in : Quality

Despite significant and important gains made by The Leapfrog Group (see  report  issued Wednesday), CHCA hospitals continue to push the ratings organization to improve its CPOE simulator tool for pediatrics.  While the CHCA Leapfrog Group Task Force (Task Force) strongly endorses CPOE testing, the absence of pediatric specific measures in the simulator can result in frequent false alerts, causing potentially dangerous alert fatigue in children’s hospitals, and low 2010 survey scores due to inappropriate triggers.

“We have concerns regarding the lack of pediatric focus in the Leapfrog CPOE flight simulator, particularly noting that the evidence in Pediatrics strongly suggests that drug-drug interactions and drug class duplications are NOT frequent causes of harm in children,” said Chris Longhurst, M.D., M.S., Chief Medical Information Officer at Lucile Packard Children’s Hospital at Stanford. This situation leads to frequent false alerts in the CPOE system, which can cause alert fatigue–a dangerous precedent if all alerts are overlooked.  Many of CHCA Owner Hospitals, who just submitted their 2010 surveys, are also reporting low scores due to the inappropriate triggers.

Please be aware of the steps CHCA and the Task Force are taking:

You may want to discuss your recently completed 2010 scores with your quality and safety leadership to find out if this issue affects your hospital. If you have any questions, please contact Sherrie Graham, who leads the Task Force, at sherrie.graham@chca.com. 

Leapfrog Group Report on CPOE Evaluation Tool Results
June 2008 to January 2010
Executive Summary

Using The Leapfrog Group’s web-based simulation tool, 214 hospitals tested their computerized physician order entry (CPOE) systems for their ability to detect common medication errors and errors that could lead to fatalities. The CPOE systems on average missed one half of the routine medication orders and a third of the potentially fatal orders. Nearly all of the hospitals improved their performance after adjusting their systems and protocols, and running the simulation a second time. The simulations were conducted from June 2008 to January 2010. Comparisons for both adult and pediatric hospitals are included (see complete report here).

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Study Finds 10x Increase in MRSA Hospitalizations in Recent Years
July 11, 2010

Posted by chcablogadmin in : Quality

Is our use of antibiotics in children’s hospitals making it harder to treat serious infections? A recent study in Pediatrics that used PHIS data from 25 CHCA hospitals reported a 10-fold increase in hospitalizations due to MRSA as well as an increase in use of clindamycin in these children. I encourage you to share the Pediatrics article with your infectious disease team as well as Dr. Newland’s analysis below. — Don

Jason Newland, M.D.

by Jason Newland, M.D.
Director, Antibiotic Stewardship Program; Director, Office of Evidence Base Practice, and Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine

Methicillin-resistant Staphylococcus aureus (MRSA) was first observed in the 1960s following the introduction of methicillin to treat penicillin-resistant S. aureus.  While MRSA was initially only seen among patients that were hospitalized, this changed in the mid 1990s when children were observed to have MRSA infections, primarily skin and soft tissue, that had no risk factors associated with the hospital-acquired strains.  Literature has continued to be published demonstrating an increase in MRSA infections being seen in children’s hospitals.  These are both hospital acquired and community associated infections (CA-MRSA).

An important feature of the CA-MRSA was now antibiotics such as clindamycin are effective.  In light of the new susceptibility profiles, treatment has changed among practitioners caring for children.  Among the CHCA hospitals since 1999, the use of clindamycin has increased among inpatients with S. aureus infections from approximately 10% of cases to now over 60% of cases.  This increase is important as resistance rates of S. aureus, whether it is MRSA or methicillin-susceptible S. aureus, are increasing.  It is essential for clinicians to know the percentage of ALL their S. aureus that are resistant to clindamycin.  Furthermore, we have to continue to strive to use our antibiotics wisely. One way to do this in the hospital is developing antimicrobial stewardship programs.

Other antibiotics have been developed that are effective against MRSA.  The newer antibiotics include linezolid, quinupristin/dalfopristin, daptomycin, tigecycline, dalbavancin and ceftobiprole.  Linezolid has the most data on use in children and is orally available.  All the other agents have limited data in pediatrics and are only via IV.

As children’s hospitals we need to help prevent the transmission of this bacteria.  While contact isolation should be used, the most important strategy is HAND HYGIENE.  It has been shown that health care workers hand hygiene compliance is poor despite its importance.  Additionally, health care providers must perform hand hygiene properly whether it is with soap and water or hand sanitizing gels.  All hospitals should have plans in place to monitor and improve hand hygiene.

Eliminating hospital acquired infections will aid in decreasing a small portion of the MRSA being seen. Importantly, we as children’s hospitals need to strive for zero hospital acquired infections occurring.  This can be done through standardizing and performing the best practices with the following: central venous lines, surgical prep, and prophylaxis, ventilator/hospital acquired pneumonia, etc.

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