Background Medicines errors related to prescriptions are frequent. These errors are more serious and frequent in children than in adults because of the need to adjust doses and manipulate pharmaceutical forms, according to the patient’s weight/age. Hospital computerised physician order entry (CPOE) systems reduce prescribing errors, especially when they have decision support tools. The use of standard protocols, with prefixed doses based on weight, body surface area or age parameters, for one or more medicines at the same time, helps to minimise errors and increase efficiency.
In recent years, our children’s hospital has brought CPOE to all inpatient wards, including standard protocols as a support tool. The number of protocols available in our CPOE system increased from 77 to 168 in the last year, with 136 of them designed for paediatric patients.
Purpose To describe the use of standard protocols in a paediatric hospital as a way to improve safety and quality in patient care.
Materials and methods Setting: University Children’s Hospital with 262 paediatric beds (including neonates), with CPOE in all wards. The CPOE system available is Savac.
To analyse the acceptance and usefulness of the standard protocols designed, we did a transversal study of all medical prescriptions in the paediatric area and the protocols used over 24 h.
Results In a 24-h period we found that:
A total of 173 paediatric patients were prescribed something (38 of them in the neonatal area). 56 of them had standard protocols prescribed (20 neonates), representing 32.4% of total admitted patients (66% of neonatal inpatients).
Regarding the distribution of prescribed protocols, 50% were post-surgical analgesia protocols, 35.7% were neonatal treatments and 8.9% were allergy test-related protocols (5.4% miscellaneous).
In our Pharmacy department an average monthly percentage of 10% of total medical prescriptions need a pharmaceutical intervention, mostly related to dosing errors, as is already described in neonatal and paediatric patients.
The use of protocols with dosing based on weight and indication (as many authors recommend), and the high use of protocols in CPOE we’ve observed, leads us to assume that prescription dosing errors should decrease.
Conclusions The use of protocols has been widely accepted by our hospital prescribers, as is reflected in the widespread use of them in the daily routine and also the continuous demand for new ones from different clinical areas. Nevertheless, the impact of these protocols on the decrease of medicines errors should be measurable.
Consequently, our intention is to continue working on protocol implementation with the goal of enhancing error prevention and therefore improving patient safety.
No conflict of interest.
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