Decreasing paediatric prescribing errors in a district general hospital.

BACKGROUND: In paediatric inpatients, medication errors occur as frequently as 1 in 4.2 drug orders, with up to 80% of these being prescribing errors. CONTEXT: The children's unit of a district general hospital in West Yorkshire, UK. KEY MEASURES FOR IMPROVEMENT: Prescribing errors and preventable adverse drug events STRATEGIES FOR CHANGE: (1) The introduction of a junior doctor prescribing tutorial. (2) The introduction of a bedside prescribing guideline. EFFECTS OF CHANGE: The introduction of the junior doctor prescribing tutorial decreased the prescribing errors by 46%. The introduction of a bedside prescribing guideline did not decrease prescribing errors but may have been helpful to those doctors unable to attend a prescribing tutorial. LESSONS LEARNT: By investing time and providing appropriate written resources, we have been able to reduce our paediatric prescribing errors on the children's ward by almost half.

Changes in pCO2 during air medical transport of children with closed head injuries.

OBJECTIVES: Because low partial pressure of carbon dioxide (pCO2) can be associated with posttraumatic cerebral ischemia, we conducted a study to determine whether the pCO2 level in ventilated children with closed head injuries transported by a trained team to tertiary care was optimally maintained during transport and determine whether hand-bagging or mechanical ventilation resulted in more optimal pCO2 levels after transport. METHODS: We reviewed the hospital charts and transport records of all infants and children who had sustained a head injury and were transported by a specialized pediatric transport paramedic team to a single tertiary care facility during a 12-month period. All children were intubated and ventilated either mechanically or manually. Outcome measures were final pCO2 before transport and first pCO2 on arrival in the PICU. RESULTS: Twenty-nine children (age 0.6 to 16 years, mean 7.3, median 6) met the criteria. Fourteen patients were hand-bagged (HB), and 15 were mechanically ventilated (MV). Eleven patients (5 HB and 6 MV) started in the target pCO2 range of 35 to 40 mmHg. After transport, nine patients (all MV) had pCO2 within the target range (P < 0.01). Duration of transport (mean 63 minutes, range 15-200 minutes) did not contribute to the final pCO2 level. CONCLUSION: MV improves management of pCO2 during interfacility transport. HB significantly increases the incidence of suboptimal pCO2 and hence the risk of suboptimal cerebral blood flow. MV appears mandatory, and monitoring CO2 in transit (end-tidal or preferably point-of-care testing) should further reduce the likelihood of secondary complications from cerebral ischemia.

Multiple types of the bacterium Streptococcus mutans in the human mouth and their intra-family transmission.

To identify the source of infection with the potentially cariogenic Streptococcus mutans, unstimulated saliva and two approximal plaque samples were examined from each member of 10 families, five of which were re-sampled 6 months later. Each morphological type of Strep. mutans appearing on SB-20 medium was identified by a biochemical micromethod and by bacteriocin typing. Ninety-three per cent of the 46 subjects harboured Strep. mutans and multiple types were detected in 78 per cent of adults and 46 per cent of infected children. Each mouth yielded c/e/f biotypes and 46 per cent also carried d/g types. Generally, saliva types were the same as those in plaque and the second sampling confirmed the first. Most fathers did not share strains with others in the family but all the infected children shared at least one common strain with the mother. The mother as the major source of Strep. mutans infection in young children was confirmed.