Electronic prescribing in paediatric secondary care: are harmful errors prevented?

Fox, Andy; Portlock, Jane; Brown, David T.

doi:10.1136/archdischild-2019-316859

Cited by 10 publications

(12 citation statements)

References 22 publications

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“…Children’s high reliance on individualised dosing, calculations and weight/volume conversions means that electronic prescribing, electronic health records and clinical decision support tools all have the potential to reduce errors 73. It is important to note, however, that computer systems do not prevent all errors74—and may generate new ones—and rely on paediatric-specific design and careful implementation 75. Putting in place rigorous systems to accurately record children’s weights could also help reduce errors.…”

Section: Discussionmentioning

confidence: 99%

What causes prescribing errors in children? Scoping review

et al. 2019

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Objectives(1) Systematically assemble, analyse and synthesise published evidence on causes of prescribing error in children. (2) Present results to a multidisciplinary group of paediatric prescribing stakeholders to validate findings and establish how causative factors lead to errors in practice.DesignScoping review using Arksey and O’Malley’s framework, including stakeholder consultation; qualitative evidence synthesis.MethodsWe followed the six scoping review stages. (1) Research question—the research question was ‘What is known about causes of prescribing error in children?’ (2) Search strategy—we searched MEDLINE, EMBASE, CINAHL (from inception to February 2018), grey literature and reference lists of included studies. (3) Article selection—all published evidence contributing information on the causes of prescribing error in children was eligible for inclusion. We included review articles as secondary evidence to broaden understanding. (4) Charting data—results were collated in a custom data charting form. (5) Reporting results—we summarised article characteristics, extracted causal evidence and thematically synthesised findings. (6) Stakeholder consultation—results were presented to a multidisciplinary focus group of six prescribing stakeholders to establish validity, relevance and mechanisms by which causes lead to errors in practice.Results68 articles were included. We identified six main causes of prescribing errors: children’s fundamental differences led to individualised dosing and calculations; off-licence prescribing; medication formulations; communication with children; and experience working with children. Primary evidence clarifying causes was lacking.ConclusionsSpecific factors complicate prescribing for children and increase risk of errors. Primary research is needed to confirm and elaborate these causes of error. In the meantime, this review uses existing evidence to make provisional paediatric-specific recommendations for policy, practice and education.

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Section: Discussionmentioning

confidence: 99%

What causes prescribing errors in children? Scoping review

et al. 2019

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“…The results with ePMA are encouraging, however there is a potential to optimize the functionality of electronic systems to improve safe prescribing of insulin in hospitals in the UK [29,30,35]. The findings provide a useful basis for further research in the field of key parameters to be included by ePMA vendors, for consistency, to ensure medication safety benefits for high risk medicines such as insulin.…”

Section: Interpretations and Implications For Practicementioning

confidence: 84%

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Setra

Jani

2021

Pharmacy

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Accurate and complete prescriptions of insulin are crucial to prevent medication errors from occurring. Two core components for safe insulin prescriptions are the word ‘units’ being written in full for the dose, and clear documentation of the insulin device alongside the name. A retrospective review of annual audit data was conducted for insulin prescriptions to assess the impact of changes to the prescribing system within a secondary care setting, at five time points over a period of 7 years (2014 to 2020). The review points were based on when changes were made, from standardized paper charts with a dedicated section for insulin prescribing, to a standalone hospital wide electronic prescribing and medicines administration (ePMA) system, and finally an integrated electronic health record system (EHRS). The measured outcomes were compliance with recommended standards for documentation of ‘units’ in full, and inclusion of the insulin device as part of the prescription. Overall, an improvement was seen in both outcomes of interest. Device documentation improved incrementally with each system change—34% for paper charts, 23%–56% for standalone ePMA, and 100% for ePMA integrated within EHRS. Findings highlight that differences in ePMA systems may have varying impact on safe prescribing practices.

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“…Electronic prescribing and medicines administration (ePMA) systems, and inbuilt prescribing aids known as computerised provider order entry (CPOE) systems, can reduce prescribing errors8–11 but vary greatly in setup, use and optimisation. Many of those currently used in UK paediatric secondary care do not have sufficient clinical decision support to prevent >90% of simulated prescribing errors12 and can introduce new methods of error 10 13. Their efficacy should therefore be evaluated and not assumed.…”

Section: The Problemmentioning

confidence: 99%

Reducing prescribing errors: making electronic prescribing work for cystic fibrosis inpatients

Vittery¹,

Bayliss

Heed

et al. 2022

Arch Dis Child Educ Pract Ed

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Children admitted to our hospital with cystic fibrosis had frequent medication errors due to polypharmacy and addition of specialist and high-risk medications despite an electronic prescribing and medicines administration system in place. We describe a multidisciplinary quality improvement project that combined a computerised order entry system (CPOE) with human factor process changes. Over 12 months, our run chart showed a 43% reduction in prescription errors. For medications prescribable via the CPOE, errors reaching the patient reduced from 50% to 29%. Electronic prescribing can be seen by clinicians as a fixed unalterable system contributing to rather than ameliorating errors. Improving safety requires whole team engagement and working closely with programmers to adapt function and influence human factors.

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Electronic prescribing in paediatric secondary care: are harmful errors prevented?

Cited by 10 publications

References 22 publications

What causes prescribing errors in children? Scoping review

What causes prescribing errors in children? Scoping review

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Reducing prescribing errors: making electronic prescribing work for cystic fibrosis inpatients

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