ABSTRACT The objective of the proposed research is to improve pediatric medication safety in the electronic health record (EHR) through optimization, deployment, and testing of an assessment tool designed to identify pediatric weight- based dosing errors. The self-evaluation tool is designed for use by any healthcare provider organization, regardless of usability expertise or informatics resources. In Aim 1, we will optimize an existing pediatric medication safety evaluation tool for the EHR by engaging with subject matter experts in pediatrics, medication safety, tool development, and informatics; this tool was developed through funding from the Pennsylvania Patient Safety Authority. We will use the evidence-based implementation framework of Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) to deploy and test the tool. In Aim 2, we will deploy the tool for testing in at least twenty different healthcare provider organizations that will be purposefully selected to ensure diversity in geographical location, patient population, and EHR vendor. In Aim 3, we will compare pediatric medication errors between sites that are able to make changes in the EHR to address items flagged as deficient on the assessment tool vs. those that are unable to make the changes. The research effort is a unique collaboration between MedStar Health's National Center for Human Factors in Healthcare and Children's Healthcare of Atlanta/Emory University. This project utilizes the collective expertise of the diverse research team which includes human factors engineering, pediatric medication safety, health information technology, usability, and patient safety. The research team has extensive experience developing assessment tools, disseminating these tools for widespread use, and identifying important areas for technology and safety improvement. At the end of this project, we will have developed a tool with accompanying test cases to assess EHR safety for pediatric weight-based dosing errors. In addition, we will also identify barriers and facilitators to tool use across settings with varying levels of resource availability. Finally, we will develop recommendations on how to customize the tool to enable assessment across diverse healthcare settings that have varying levels of resources available for improving patient safety and quality.

PROJECT NARRATIVE Safety assessment of electronic health records focuses on adult populations, even though challenges with health information technology contribute to a large portion of errors in pediatric populations, specifically medication errors in pediatric weight-based dosing. Our proposal will engage subject matter experts in pediatrics, medication safety, and informatics to optimize a tool to assess pediatric medication safety, test this tool across at least 20 hospitals, and measure the impact of changes made as a result of the assessment system on medication safety. The assessment tool can be applied across diverse healthcare settings as a robust, low-cost method of assessing and optimizing pediatric medication safety.