Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its impact in the paediatric setting remains limited. In 2012, the paediatric intensive care unit (PICU) of an Irish tertiary children’s hospital implemented electronic-prescribing and a smart-pump library of standard concentration infusions (SCIs).

Purpose To assess the impact of the newly implemented technology on medication errors in the PICU.

Material and methods A retrospective, observational study of medication errors as identified by clinical pharmacist review was conducted. An interrupted time series design with four time periods was employed: pre-implementation; post-implementation of SCIs; immediate post-implementation of electronic-prescribing; and 1 year post-implementation. Pre-determined error definitions and validated grading tools were used in conjunction with a multi-disciplinary consensus process.^1–3 Data were analysed in Stata Version 13.1 using ANOVA and Chi-squared tests.

Results 3356 medication orders from 288 random patients were included. Identified errors were almost exclusively prescribing, with a similar prevalence pre- and post-implementation (10.2% v 9.8%; p=0.66). Incomplete and wrong unit errors were eradicated, however duplicate orders increased. Dose prescribing errors remained the most common. Seventy seven per cent of pre-implementation and 24% of post-implementation prescribing errors were categorised as paper-based and technology-generated, respectively. The implementation of SCIs pre-electronic-prescribing significantly reduced infusion-related prescribing errors (29% to 14.6%; p<0.01). A further reduction to 8.4% (p>0.05) was reported after implementation of electronically-generated infusion orders. A significant reduction in the severity of infusion errors was found, with no differences in non-infusion errors. Almost all errors were minor, causing no patient harm.

Conclusion The overall prevalence of errors in the PICU was unchanged. Altered error distribution was evident with many paper-based errors disappearing but new technology-generated errors emerging. In the complex PICU environment, prescribing errors remain common. The benefits of SCIs in improving the safety of prescribing paediatric infusions was a significant finding, with electronically-generated orders likely to further enhance safety. Our results show that the benefits of HIT in the paediatric setting cannot be assumed and highlight the need for further studies, given the increasing use of HIT in paediatric settings.

Acknowledgements We would like to acknowledge the National Children’s Research Centre for funding this research and for providing biostatistical support. We would also like to thank Erika Brereton and Ian Dawkins, PICU Data Managers for their assistance.

References

1. . Ghaleb MA, Barber N, Dean Franklin B, et al. What constitutes a prescribing error in paediatrics?BMJ Qual Saf2005;14(5):352–7.

2. . Dean BS, Barber ND. A validated, reliable method of scoring the severity of medication errors. Am J Health Syst Pharm1999;56(1):57–62.

3. . National Coordinating Council for Medication Error Reporting and Prevention. Taxonomy of medication errors1998. http://www.nccmerp.org/about-medication-errors