Research: Paediatric dosing errors before and after e‐prescribing
This study compares the incidence and severity ratings of paediatric dosing errors before and after the implementation of electronic prescribing with basic clinical decision support.
Prescribing in children is complex and errors may occur at any stage during prescribing, administration by the nurse or parents or dispensing(1; 2). Dosing errors are thought to be the most common type of medication errors in this patient group. Various strategies and solutions have been used to minimise the incidence. Electronic prescribing (EP) is seen by many as one such solution with high potential for error reduction(3).
To compare the incidence and severity ratings of paediatric dosing errors before and after the implementation of electronic prescribing with basic clinical decision support.
Setting and Participants
This study was conducted at an acute tertiary care paediatric hospital during the implementation of an electronic prescribing (EP) system in the nephro‐urology unit.
Dosing errors were identified as part of a wider study, using used a practitioner derived definition of a prescribing error(4). Severity rating was determined using a validated, reliable method(5). Five experienced healthcare professionals (doctors and pharmacists) were asked to score a sample of prescribing errors in terms of potential patient outcomes on a scale of 0 to 10, where 0 represents a case with no potential effect and 10 a case that would result in death. The mean score for each error was used as an index of severity: mean score <3 = minor outcome, mean score between 3 and 7 = moderate outcome, and mean scores >7 = severe outcome(6).
The EP system is a commercially available integrated prescribing, medication administration and pharmacy system (JAC Computer Services Ltd) that does not interact with other clinical systems e.g. pathology or PACS, but patient demographic and ward information is automatically transferred from the Trust’s PAS. There was no dosing‐specific clinical decision support.
There was a 1% reduction, 95% confidence interval (CI) 0.5 to 1.6, in the overall dosing error rate from 2.2% (88/3939) to 1.2% (58/4784).
Dose errors in outpatient and discharge prescriptions reduced from 38/1574 to 9/648, (1% difference, 95% CI ‐0.4 to 2.1) and 34/1098 to 20/2057 (2.1% difference, 95% CI 1.1 to 3.4) respectively.
There was very little difference (0.03%, 95% CI ‐0.8 to 0.9) in inpatient dosing errors from 18/1267 to 29/2079.
Overall there was no significant difference in the proportions of severity ratings after EP: errors with minor outcome 35/86 pre vs. 20/56 (5% difference, 95% CI ‐11.4 to 20.4); moderate outcome 45/86 vs. 33/56 (‐6.6% difference, 95% CI ‐22.4 to 10) and severe outcome 6/86 vs. 3/56 (1.6% difference, 95% CI ‐8.4 to 9.8).
Conclusions (Preliminary analysis of research)
Electronic prescribing appears to reduce rates of dosing errors in paediatrics, but larger studies are required to assess the effect in different settings and on the severity of these errors.
Yogini Hariprasad Jani1, 2, Ian Chi Kei Wong1, 2, Nick Barber2
1. Centre for Paediatric Pharmacy Research; 2. Department of Practice and Policy, The School of Pharmacy, University of London.
1) Ghaleb MA, Wong ICK. Medication errors in paediatric patients. Arch Dis Child Ed Pract 2006 Apr 1;91(1):ep20.
2) Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA: The Journal of the American Medical Association 2001;285(16):2114‐20.
3) Kaushal R, Barker KN, Bates DW. How can information technology improve patient safety and reduce medication errors in children’s health care? Archives of Pediatrics & Adolescent Medicine 155(9):1002‐7, 2001.
4) Ghaleb MA, Barber N, Dean FB, Wong IC. What constitutes a prescribing error in paediatrics? Quality & Safety in health care 14(5):352‐7, 2005 Oct.
5) Dean BS, Barber ND. A validated, reliable method of scoring the severity of medication errors. Am J Health Syst Pharm 1999 Jan 1;56(1):57‐62.
6) Dean BS. A transatlantic study of medication system errors in hospitals. London, England: University of London; 1993.
Yogini Jani is a PhD student at University of London’s School of Pharmacy. Yogini receives funding to support her research into e-prescribing from JAC, First Databank and Great Ormond Street Hospital as part of their commitment to understanding and improving healthcare.