The combined interventions of ZTP and daily error feedback were associated with a significant reduction in prescribing errors in the PICU, in line with Department of Health requirements of a 40 % reduction within 5 years.

Terlipressin may be useful for sepsis-induced vasodilation.

Our paediatric intensive care unit (PICU) performs active surveillance for prescribing errors and detects a mean of 1.66 with an SD of 0.18 total prescription errors per occupied bed day. The primary aim of this project was to reduce the number of prescribing errors in PICU. The secondary aims were to improve the workflow in the unit and reduce the time staff spent on medication queries/prescribing. We introduced a daily multidisciplinary prescribing round to our PICU. Prescribing errors reduced, with the mean number of total prescription errors per bed day falling from 1.66 (0.18) to 1.19 (0.13), the mean number of clinical prescription errors per bed day falling from 0.46 (0.09) to 0.3 (0.07), and the mean number of non-clinical prescribing errors per bed day falling from 1.12 (0.15) to 0.67 (0.1). Forty-eight staff responded to the survey, 39 of whom had been directly involved in the rounds. The majority (37 of 39; 95%) said the prescribing round reduced the overall time they spent on prescribing/medication queries during their shift, and 9 of 10 (90%) prescribers said that they were interrupted fewer times for medication queries while doing other tasks. Almost all (47 of 48; 98%) said that they thought the prescribing ward round should continue. Introduction of a prescribing round with senior medical and pharmacist involvement was associated with a reduction in prescribing errors as well as reduction in the overall time staff spent on medication queries and prescribing. The round was well received by staff, with 98% wanting it to continue.

In the four available pediatric randomized controlled trials, selective decontamination of the digestive tract significantly reduced the number of children who developed pneumonia.

Prescription errors are frequent on intensive care units. The perception of prescribing as a low status task rather than an essential element of therapy, perceived time pressure and distractions may all be contributory factors.The authors altered practice on our tertiary paediatric intensive care unit in two stages: formal consultant review of prescription charts on daily ward rounds and requesting re-write for any errors was introduced with the aim of raising the status and visibility of prescription as a task. Subsequently, a dedicated prescription desk was provided and prescription elsewhere was not permitted. Staff were not permitted to interrupt a prescriber at this desk.The authors termed these combined interventions “zero-tolerance prescription” (ZTP) following a similar approach in Cardiff. The authors undertook an observational study of the impact of these on prescription error rates over 6 months in a tertiary paediatric intensive care unit.MethodsPrescription and administration errors have been recorded prospectively on a daily basis by our ward pharmacist against 44 criteria. These include “clinical errors” (dosage, route of administration, frequency) and non-clinical errors (signature illegible, unapproved names or abbreviations etc). Total errors adjusted for ICU occupancy (errors per occupied PICU day) are presented for three periods: (A) baseline, (B) consultant checking prescription charts and (C) full ZTP. Comparisons are made between mean error rates with t-tests. Abstract G81 Figure 1 Results(A) Baseline mean error rate over 12 weeks was 1.8 errors per occupied PICU bed day (95% CI 1.5 to 2.1), (B) In the 20 weeks following formalised consultant checking of charts, this was reduced to 1.4, errors per occupied PICU bed day (1.1–1.6) (p=0.0035 vs A). (C) Following the introduction of the full ZTP, protocol error rate was 1.1 (0.8–1.3) (p=0.001 vs A, and p<0.05 vs B) over a 10-week period. This constitutes relative risk 0.59 for error. Infusion prescriptions errors were most improved A) 0.3 day (0.2–0.4) per occupied PICU bed vs C) 0.1 (0–0.2), p=0.02 (relative risk 0.45).CommentIn this unblinded study, the ZTP package was associated with a significant and prolonged reduction in errors. The impact of these changes is likely to be highly influenced by local factors but merit consideration on PICU.