Prevention of pediatric medication errors by hospital pharmacists and the potential benefit of computerized physician order entry

Cornell University, Итак, New York, United States
PEDIATRICS (Impact Factor: 5.47). 02/2007; 119(1):e77-85. DOI: 10.1542/peds.2006-0034
Source: PubMed


The purpose of this work was to characterize medication errors and adverse drug events intercepted by a system of pediatric clinical pharmacists and to determine whether the addition of a computerized physician order entry system would improve medication safety.
The study included 16,938 medication orders for 678 admissions to the pediatric units of a large academic community hospital. Pediatric clinical pharmacists reviewed medication orders and monitored subsequent medication use. Medication errors and adverse drug events were identified by daily review of documentation, voluntary reporting, and solicitation. Each potentially harmful medication error was judged whether or not it was intercepted and, if not, whether it would have been captured by a computerized physician order entry system.
Overall, 865 medication errors occurred, corresponding with a rate of 5.2 per 100 medication orders. A near-miss rate of 0.96% and a preventable adverse drug event rate of 0.09% were observed. Overall, 78% of potentially harmful prescribing errors were intercepted; however, none of the potentially harmful errors occurring at administration was intercepted and accounted for 50% of preventable adverse drug events. A computerized physician order entry system could capture additional potentially harmful prescribing and transcription errors (54%-73%) but not administration errors (0% vs 6%).
A system of pediatric clinical pharmacists effectively intercepted inpatient prescribing errors but did not capture potentially harmful medication administration errors. The addition of a computerized physician order entry system to pharmacists is unlikely to prevent administration errors, which pose the highest risk of patient injury.

23 Reads
  • Source
    • "Role of professionally competent community pharmacists with specialized training in dispensing is pivotal. They can intercept potentially harmful prescribing errors (Wang et al., 2007) and serve as an indispensible source of information for prescribing physicians and nursing staff regarding rational prescribing practices. The American Society of Health System Pharmacists (ASHP) believes that pharmacists have a role in meeting the primary (ambulatory) care needs of patients by providing pharmaceutical care, through their expanded responsibilities in collaborative drug therapy management (Scobie et al., 2003). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose The main objective of this study was to survey pharmacists’ attitudes toward dispensing errors in community pharmacy settings in Saudi Arabia. Methods A cross-sectional survey of community pharmacists in Riyadh region, Saudi Arabia was conducted over a period of 6 months from March through September 2012. A stratified random sample of eight hundred registered pharmacy practitioners was collected all over Riyadh region. Statistical analysis was done using SPSS version19.0 for windows (SPSS Inc., Chicago, Illinois). Results The response rate was almost 82%. The majority of the respondents are young adults (90.2%). The median for years of registration of respondent pharmacists was 9 years (range 1–37 years). About 62% (407) of the respondents have a positive response while only 37.8% (n = 248) have a negative response in this respect. The major factors identified were pharmacist assistant (82.2%) and high workload (72.5%). The most appreciated factors that help reducing dispensing errors are improving doctors’ hand writing and reducing work load of the pharmacist (82.9% and 82.8% respectively), having drug names that are distinctive (76.1%) and having more than one pharmacist in duty (75.5%). Conclusion In conclusion, majority of community pharmacists indicated that the risk of dispensing errors was increasing and most of them were aware of dispensing errors. It is obvious from the study results that dispensing errors is a big concern for community pharmacy practice in Saudi Arabia. Therefore, there is an urgent need for the professional organizations and Pharmacy Boards in Saudi Arabia to determine standards for the profession.
    Saudi Pharmaceutical Journal 07/2014; 22(3):195–202. DOI:10.1016/j.jsps.2013.05.002 · 1.28 Impact Factor
  • Source
    • "A measure of reliability was established for 17 (43 %) tools (ESM Table 2) [9, 11, 15, 16, 24, 28, 31, 33, 34, 37–39, 48, 50, 63, 67, 68]. In all cases this was inter-rater reliability, which could be particularly important where potential harm was being assessed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Prescribing errors are common. It has been suggested that the severity as well as the frequency of errors should be assessed when measuring prescribing error rates. This would provide more clinically relevant information, and allow more complete evaluation of the effectiveness of interventions designed to reduce errors. The objective of this systematic review was to describe the tools used to assess prescribing error severity in studies reporting hospital prescribing error rates. The following databases were searched: MEDLINE, EMBASE, International Pharmaceutical Abstracts, and CINAHL (January 1985-January 2013). We included studies that reported the detection and rate of prescribing errors in prescriptions for adult and/or pediatric hospital inpatients, or elaborated on the properties of severity assessment tools used by these studies. Studies not published in English, or that evaluated errors for only one disease or drug class, one route of administration, or one type of prescribing error, were excluded, as were letters and conference abstracts. One reviewer screened all abstracts and obtained complete articles. A second reviewer assessed 10 % of all abstracts and complete articles to check reliability of the screening process. Tools were appraised for country and method of development, whether the tool assessed actual or potential harm, levels of severity assessed, and results of any validity and reliability studies. Fifty-seven percent of 107 studies measuring prescribing error rates included an assessment of severity. Forty tools were identified that assessed severity, only two of which had acceptable reliability and validity. In general, little information was given on the method of development or ease of use of the tools, although one tool required four reviewers and was thus potentially time consuming. The review was limited to studies written in English. One of the review authors was also the author of one of the tools, giving a potential source of bias. A wide range of severity assessment tools are used in the literature. Developing a basis of comparison between tools would potentially be helpful in comparing findings across studies. There is a potential need to establish a less time-consuming method of measuring severity of prescribing error, with acceptable international reliability and validity.
    Drug Safety 08/2013; 36(12). DOI:10.1007/s40264-013-0092-0 · 2.82 Impact Factor
  • Source
    • "Wang et al35 studied medication errors and ADEs among pediatric inpatients in a large academic community hospital. Among 16,938 medication orders in 678 admissions, there were 865 medication errors noted, a rate of 5.2 per 100 orders. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Medication errors affect the pediatric age group in all settings: outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies.
    Health Services Insights 06/2013; 6:47-59. DOI:10.4137/HSI.S10454
Show more