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.

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    • "While these technologies have demonstrated the capacity to decrease the frequency of errors [15] [16] [17], 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 harm [20] [21] [22] [23] [24] [25] [26]. Notably, others have uncovered associations between CPOE and new and unanticipated errors as well as harm [27] [28] [29] [30]. "
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    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
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    • "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). "
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    Preview · Article · Jul 2014 · Saudi Pharmaceutical Journal
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    • "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. "
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    Full-text · Article · Aug 2013 · Drug Safety
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