Pediatric clinics of North America
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Pediatr. Clin. North Am. · Dec 2012
The emerging role of simulation education to achieve patient safety: translating deliberate practice and debriefing to save lives.
Simulation-based educational processes are emerging as key tools for assessing and improving patient safety. Multidisciplinary or interprofessional simulation training can be used to optimize crew resource management and safe communication principles. ⋯ Emerging evidence supports that procedural simulation, deliberate practice, and debriefing can also improve operational performance in clinical settings and can result in safer patient and population/system outcomes in selected settings. This article highlights emerging evidence that shows how simulation-based interventions and education contribute to safer, more efficient systems of care that save lives.
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"Smart" infusion pumps are medication delivery devices that use a combination of computer technology and drug libraries to limit the potential for dosing errors. The evidence for their impact is limited: they have been shown to prevent some errors but there are minimal data linking the devices to reducing harm. Reasons for the limited impact include poor design leading to usability issues including programming errors, varying degrees of end-user acceptance, and their contingent nature. Iterative user-centered design, coupled with network and real-time monitoring of alerts may enhance the impact of these devices.
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Pediatr. Clin. North Am. · Dec 2012
Sleep science, schedules, and safety in hospitals: challenges and solutions for pediatric providers.
Sleep deprivation is common among resident physicians and clinical fellows. Current evidence about sleep science, performance, shift work, and medical errors consistently demonstrates positive impact from reduction of excessive duty hours, particularly when shift length is shortened. ⋯ Accreditation Council on Graduate Medical Education trainee duty hour guidelines are reviewed. Practical approaches to evidence-based scheduling of shift-work are also discussed, with attention to improving patient safety.
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Pediatr. Clin. North Am. · Oct 2012
The impact of extracorporeal life support and hypothermia on drug disposition in critically ill infants and children.
Extracorporeal membrane oxygenation (ECMO) support is an established lifesaving therapy for potentially reversible respiratory or cardiac failure. In 10% of all pediatric patients receiving ECMO, ECMO therapy is initiated during or after cardiopulmonary resuscitation. ⋯ Hypothermia is frequently used in children and neonates during cardiopulmonary bypass (CPB). By combining data from pharmacokinetic studies in children on ECMO and CPB and during hypothermia, this review elucidates the possible effects of hypothermia during ECMO on drug disposition.