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

ArticleinPEDIATRICS 119(1):e77-85 · February 2007with35 Reads
DOI: 10.1542/peds.2006-0034 · Source: PubMed
Abstract
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.
    • "In an earlier study at two teaching hospitals, 616 MEs were found out of 10778 observed medication doses at a rate of (5.7%) (Kaushel et al., 2001). Among 16,938 medication orders in a study on pediatric inpatients at a large academic community hospital, there were 865 medication errors noted, a rate of 5.2 per 100 orders (Wang et al., 2007). In the current study, medication errors constitute (6.7%) of all the administrations: 1467 errors out of 21843observations. "
    [Show abstract] [Hide abstract] ABSTRACT: Medication errors have significant implications on patient safety. Error detection through an active management and effective reporting system discloses medication errors and encourages safe practices.OBJECTIVES: To improve patient safety through determining and reducing the major causes of medication errors (MEs), after applying tailored preventive strategies.METHODOLOGY: A pre-test, post-test study was conducted on all inpatients at a 177 bed hospital where all medication procedures in each ward were monitored by a clinical pharmacist. The patient files were reviewed, as well. Error reports were submitted to a hospital multidisciplinary committee to identify major causes of errors. Accordingly, corrective interventions that consisted of targeted training programs for nurses and physicians were conducted.RESULTS: Medication errors were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). About 45% of errors reached the patients: 43.5% were harmless and 1.4% harmful. 7.7% were potential errors and more than 47% could be prevented. After the intervention, error rates decreased from (6.7%) to (3.6%) (P≤0.001).CONCLUSION: The role of a ward based clinical pharmacist with a hospital multidisciplinary committee was effective in recognizing, designing and implementing tailored interventions for reduction of medication errors. A systematic approach is urgently needed to decrease organizational susceptibility to errors, through providing required resources to monitor, analyze and implement effective interventions.
    Full-text · Article · Dec 2015
    • "While these technologies have demonstrated the capacity to decrease the frequency of errors151617, results are mixed in studies trying to document reduction in harm. While some have been able to show a decrease in mortality [18, 19], others have failed to demonstrate efficacy of the technology or reduction in harm20212223242526. Notably, others have uncovered associations between CPOE and new and unanticipated errors as well as harm27282930. "
    [Show abstract] [Hide abstract] ABSTRACT: . The ability of safety technologies to decrease errors, harm, and risk to patients has yet to be demonstrated consistently. Objective . To compare discrepancies between medication and intravenous fluid (IVF) orders and bedside infusion pump settings within a pediatric intensive care unit (PICU) before and after implementation of an interface between computerized physician order entry (CPOE) and pharmacy systems. Methods . Within a 72-bed PICU, medication and IVF orders in the CPOE system and bedside infusion pump settings were collected. Rates of discrepancy were calculated and categorized by type. Results were compared to a study conducted prior to interface implementation. Expansion of PICU also occurred between study periods. Results . Of 455 observations, discrepancy rate decreased for IVF ( p = 0.01 ) compared to previous study. Overall discrepancy rate for medications was unchanged; however, medications infusing without an order decreased ( p < 0.01 ), and orders without corresponding infusion increased ( p < 0.05 ). Conclusions . Following implementation of an interface between CPOE and pharmacy systems, fewer discrepancies between IVF orders and infusion pump settings were observed. Discrepancies for medications did not change, and some types of discrepancies increased. In addition to interface implementation, changes in healthcare delivery and workflow related to ICU expansion contributed to observed changes.
    Full-text · Article · Dec 2015
    • "While some of these events may be due to the absence of validated labeling, a recent review on medication errors found that drug therapy problems occurring in non-inpatient settings are both underreported and lack consistent definitions [3]. It has been reported that computerized provider order entry systems (CPOE) in hospitals reduce the likelihood of certain errors in children by as much as 50%456. The few studies that identify and summarize pharmacotherapy problems and medication errors in children residing at home revealed an overall rate of 70.2 errors per 100 patients, and a median preventable adverse drug event (pADE) rate of 16.5% [7,8]. "
    [Show abstract] [Hide abstract] ABSTRACT: Children need a distinct medicines-use system designed explicitly for them since their continued inclusion in a system of prescription processing developed for adults generates insoluble risk points and workarounds. The American Academy of Pediatrics (AAP), in its policy statement released by the AAP Committee on Drugs in early 2014 about off-label use in children, posits that federal legislation on increased drug testing in children has been effective, as " there have been over 500 pediatric-specific labeling changes. " However, the AAP's position has not changed materially since the original 2002 policy statement. Indeed, other health professionals, their organizations, or affiliated practice-based research network (PBRNs) mechanisms continue to be excluded from consideration, collaboration, or even honorable mention. It is noteworthy that most of the 500 labeling changes made since 1997 have addressed the scientific validity of indications for medication use in pediatric population without regard to pharmacotherapy formulation or monitoring. Medication use in children continues to be associated with an unacceptably high rate of adverse events, morbidity, and death. Children should no longer be " shoehorned " into the adult medication-use system, which faces challenges in addressing even the adult population's needs. The time is now to design a multi-phasic, systematic approach to the pharmacotherapy of children. This paper will argue for the establishment of a distinct medication use system for children, a trans-disciplinary system designed thoughtfully and intentionally, not by
    Full-text · Article · Jun 2015
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