Log in | Register

Impact of an intervention to reduce prescribing errors in a pediatric intensive care unit

Amalia Martinez-Anton| J. Ignacio Sanchez| Lidia Casanueva
Pediatric Original
Volume 38, Issue 9 / September , 2012

Pages 1532 - 1538

Abstract

Purpose

To identify and reduce medication prescribing errors in a pediatric intensive care unit (PICU) by means of an educational program designed to improve medical prescriptions.

Methods

Before–after interventional study in a tertiary-level PICU. Handwritten prescriptions were prospectively collected: 2,228 during period 1 and 1,791 during period 2. In both periods elements of good prescribing practice including error indicators and quality indicators were studied. The interventional program included four measures: standardization of prescription sources, pocket tables with dosing guidelines, an updated prescription protocol, and an educational program on correct prescribing.

Results

The prescribing error (PE) rate decreased from 34.2 to 21.7 % after the intervention. Lack of administration route was considered separately for its high prevalence, 30 and 20.8 % of prescriptions, respectively. The most frequent error was presence of some illegible element (59 %). Legibility was the element of prescription experiencing the greatest reduction in error rate, from 4.1 % of prescriptions with one or more illegible elements in period 1 to 0.2 % in period 2. Tenfold overdosage decreased from two cases in period 1 to one case in period 2. The attending physician and on-call physician were associated with more PEs in both periods. The number of prescriptions with two or more errors decreased from 3.1 to 0.7 %. Errors reaching the patient were scarce, 14 (0.63 %) in period 1 and 6 (0.34 %) in period 2, without adverse events.

Conclusions

Implementation of an educational program for physicians may significantly reduce the prescribing error rate in a PICU.

Keywords

References

  1. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA (2008) The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 17:216–223
    • View reference on PubMed
    • View reference on publisher's website
  2. Aranaz JM, Aibar C, Vitaller J, Ruiz P (2006). In: Estudio Nacional sobre los Efectos Adversos ligados a la Hospitalización. ENEAS 2005. Ministerio de Sanidad y Consumo. Depósito legal: M. 19200-2006
  3. Eisenberg JM, Foster NE, Meyer G, Holland H (2001) Federal efforts to improve quality of care: the quality interagency coordination task force (QuIC). Jt Comm J Qual Improv 27:93–100
    • View reference on PubMed
  4. Hartwig SC, Denger SD, Schneider PJ (1991) Severity-indexed, incident report-based medication error-reporting program. Am J Hosp Pharm 48:2611–2616
    • View reference on PubMed
  5. Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, Hallisey R, Ives J, Laird N, Laffel G et al (1995) Systems analysis of adverse drug events. ADE prevention study group. JAMA 274:35–43
    • View reference on PubMed
    • View reference on publisher's website
  6. Vincer MJ, Murray JM, Yuill A, Allen AC, Evans JR, Stinson DA (1989) Drug errors and incidents in a neonatal intensive care unit. A quality assurance activity. Am J Dis Child 143:737–740
    • View reference on PubMed
  7. Wilson DG, McArtney RG, Newcombe RG, McArtney RJ, Gracie J, Kirk CR, Stuart AG (1998) Medication errors in paediatric practice: insights from a continuous quality improvement approach. Eur J Pediatr 157:769–774
    • View reference on PubMed
    • View reference on publisher's website
  8. Sutcliffe AG (1999) Prescribing medicines for children. BMJ 319:70–71
    • View reference on PubMed
    • View reference on publisher's website
  9. Raju TN, Kecskes S, Thornton JP, Perry M, Feldman S (1989) Medication errors in neonatal and paediatric intensive-care units. Lancet 2:374–376
    • View reference on PubMed
    • View reference on publisher's website
  10. Jonville AP, Autret E, Bavoux F, Bertrand PP, Barbier P, Gauchez AS (1991) Characteristics of medication errors in pediatrics. DICP 25:1113–1118
    • View reference on PubMed
  11. Campino A, Lopez-Herrera MC, Lopez-de-Heredia I, Valls-i-Soler A (2009) Educational strategy to reduce medication errors in a neonatal intensive care unit. Acta Paediatr 98:782–785
    • View reference on PubMed
    • View reference on publisher's website
  12. Pallas CR, De-la-Cruz J, Del-Moral MT, Lora D, Malalana MA (2008) Improving the quality of medical prescriptions in neonatal units. Neonatology 93:251–256
    • View reference on PubMed
    • View reference on publisher's website
  13. Burmester MK, Dionne R, Thiagarajan RR, Laussen PC (2008) Interventions to reduce medication prescribing errors in a paediatric cardiac intensive care unit. Intensive Care Med 34:1083–1090
  14. Cimino MA, Kirschbaum MS, Brodsky L, Shaha SH (2004) Assessing medication prescribing errors in pediatric intensive care units. Pediatr Crit Care Med 5:124–132
    • View reference on PubMed
    • View reference on publisher's website
  15. Potts AL, Barr FE, Gregory DF, Wright L, Patel NR (2004) Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics 113:59–63
    • View reference on PubMed
    • View reference on publisher's website
  16. Folli HL, Poole RL, Benitz WE, Russo JC (1987) Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics 79:718–722
    • View reference on PubMed
  17. Dean B, Barber N, Schachter M (2000) What is a prescribing error? Qual Health Care 9:232–237
    • View reference on PubMed
    • View reference on publisher's website
  18. (1998) Prevention of medication errors in the pediatric inpatient setting. American Academy of Pediatrics. Committee on drugs and committee on hospital care. Pediatrics 102:428–430
  19. Otero Lopez MJ, Codina Jane C, Tames Alonso MJ, Perez Encinas M (2003) Medication errors: standarizing the terminology and taxomany. Ruiz Jarabo 2000 grand results. Farm Hosp 27:137–149
    • View reference on PubMed
  20. Kohn LT, Corrigan J, Donaldson MS (2000) To err is human: building a safer health system. National Academy Press, Washington
  21. Taketomo CK, Hodding JH, Kraus DM (2008) Pediatric dosage handbook. Lexi-Comp, Hudson
  22. Colpaert K, Decruyenaere J (2009) Computerized physician order entry in critical care. Best Pract Res Clin Anaesthesiol 23:27–38
    • View reference on PubMed
    • View reference on publisher's website
  23. Warrick C, Naik H, Avis S, Fletcher P, Franklin BD, Inwald D (2011) A clinical information system reduces medication errors in paediatric intensive care. Intensive Care Med 37:691–694
  24. Perren A, Conte P, De Bitonti N, Limoni C, Merlani P (2008) From the ICU to the ward: cross-checking of the physician’s transfer report by intensive care nurses. Intensive Care Med 34:2054–2061
  25. Reason J (2000) Human error: models and management. BMJ 320:768–770
    • View reference on PubMed
    • View reference on publisher's website
  26. McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P (2007) The Hawthorne effect: a randomised, controlled trial. BMC Med Res Methodol 7:30
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement