[Social pediatric care situation and needs during the COVID-19 pandemic from 2020 to 2022. What is needed now?] / Sozialpädiatrische Versorgungssituation und -bedarfe in Zeiten der COVID-19-Pandemie 2020 bis 2022. Was wird jetzt gebraucht?

BACKGROUND: Children and adolescents with social pediatric care needs represent a group with special challenges. The aim of this qualitative study was to describe social pediatric care during the pandemic from the perspective of experts. From this, conclusions were to be drawn for any social pediatric care needs that may have arisen. METHODS: Between May and November 2022, 25 experts from the field of social pediatrics were interviewed using guided interviews on the following topics: deviations in care, utilization behavior of families, individual burdens and resources, and sustainable needs. The interviews were analyzed by two research assistants. RESULTS: Overall, the social pediatric care offer was temporarily clearly limited. While families who were already well connected before the pandemic could be adequately cared for with the help of telephone/video contacts, an unreported number of at-risk groups, were described, for example, those with low competence to act, who did not make use of services or did so with delays. It was observed that there was a need for care for newly developed mental disorders and regression in therapy due to limited opportunities for support, as well as a need to catch up on missed opportunities for early support in the case of developmental disorders. DISCUSSION: To meet the needs that have arisen, underserved families should be identified and cared for promptly, taking individual characteristics into account. To this end, for example, more outreach services should be established that reach affected families unbureaucratically.

Application of the Pareto principle to identify and address drug-therapy safety issues.

PURPOSE: Adverse drug events (ADE) and medication errors (ME) are common causes of morbidity in patients presenting at emergency departments (ED). Recognition of ADE as being drug related and prevention of ME are key to enhancing pharmacotherapy safety in ED. We assessed the applicability of the Pareto principle (~80 % of effects result from 20 % of causes) to address locally relevant problems of drug therapy. METHODS: In 752 cases consecutively admitted to the nontraumatic ED of a major regional hospital, ADE, ME, contributing drugs, preventability, and detection rates of ADE by ED staff were investigated. Symptoms, errors, and drugs were sorted by frequency in order to apply the Pareto principle. RESULTS: In total, 242 ADE were observed, and 148 (61.2 %) were assessed as preventable. ADE contributed to 110 inpatient hospitalizations. The ten most frequent symptoms were causally involved in 88 (80.0 %) inpatient hospitalizations. Only 45 (18.6 %) ADE were recognized as drug-related problems until discharge from the ED. A limited set of 33 drugs accounted for 184 (76.0 %) ADE; ME contributed to 57 ADE. Frequency-based listing of ADE, ME, and drugs involved allowed identification of the most relevant problems and development of easily to implement safety measures, such as wall and pocket charts. CONCLUSIONS: The Pareto principle provides a method for identifying the locally most relevant ADE, ME, and involved drugs. This permits subsequent development of interventions to increase patient safety in the ED admission process that best suit local needs.

Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS).

BACKGROUND: Lists of potentially inappropriate medications (PIMs) for the elderly, such as the German PRISCUS list, have been published as expert recommendations with the aim of improving drug safety for this patient group. In this study, we tried to determine how often adverse drug events occur in the emergency department and what role PRISCUS medications might play in these events. METHODS: We prospectively reviewed the medical records of 752 patients who were treated in the emergency department (ED) of a level III hospital in Germany for adverse drug events due to medication errors (MEs) and for adverse drug reactions (ADRs). The evaluation was performed in two steps by pharmacologists, clinical pharmacologists, and board-certified internists. RESULTS: Both clinically important MEs and ADRs became more common with advancing age. Among the 351 patients who were over age 65, 307 (87.5%) were taking at least one medication at home. Of these 307 patients, 16.6% (95% confidence interval [CI]: 12.9-21.2%) were taking at least one PIM, as defined by the German PRISCUS list. In relative terms, PIMs were more commonly associated with ADRs or MEs than other drugs (27.0% [95% CI: 17.5-39.1% versus 15.7% [95% CI: 14.1-17.4%], Odds ratio 1.99 [95% CI: 1.23-3.52: p = 0.018), but in absolute terms ADRs and MEs involved non-PIM more often than PIM. CONCLUSION: Elderly patients more frequently suffer from ADR and from the clinical consequences of medication errors. Elderly patients taking PIMs are more likely to suffer from ADRs and MEs, even though most drug-related events are still attributable to non-PIM.