For children admitted to hospital, what interventions improve medication safety on ward rounds? A systematic review

Abstract

ObjectiveEvery year, medication errors harm children in hospitals. Ward rounds are a unique opportunity to bring information together and plan management. There is a need to understand what strategies can improve medication safety on ward rounds. We systematically reviewed published interventions to improve prescribing and safety of medicines on ward rounds.DesignSystematic review of randomised controlled trials and observational studies.SettingStudies examining inpatient ward rounds.PatientsChildren and young people aged between 0 and 18 years old.InterventionsAny intervention or combination of interventions implemented that alters how paediatric ward rounds review inpatient medications.Main outcome measurePrimary outcome was improvement in medication safety on paediatric ward rounds. This included reduction in prescribing error rates, healthcare professionals’ opinions on prescribing and improvement in documentation on ward rounds.ResultsThree studies were eligible for review. One examined the use of an acrostic, one the use of a checklist, and the other a use of a specific prescribing ward round involving a clinical pharmacist and doctor. None of the papers considered weight-based errors or demonstrated reductions in clinical harm. Reductions in prescribing errors were noted by the different interventions.ConclusionsThere are limited data on interventions to improve medication safety in paediatric ward rounds, with all published data being small scale, either quality improvement or audits, and locally derived/delivered. Good-quality interventional or robust quality improvement studies are required to improve medication safety on ward rounds.PROSPERO registration numberCRD42022340201.

Medication Safety Gaps in English Pediatric Inpatient Units: An Exploration Using Work Domain Analysis

“…We suggest that consideration be given to the structure and function of the wider care team in these settings, with a view to exploring how skill mix may improve safety outcomes. For example, there has been evidence that pharmacist participation in ward rounds may lead to reduced medication errors 44–47 but the framework for this participation in the UK setting is unclear 48 . All research into pharmacist impact on medication errors is through a lens of retrospective prescribing interventions rather than proactive clinical activity; thus, there are also economic and workforce considerations to acknowledge around staffing and outcome measures.…”

Low-quality evidence for medication errors reduction strategies in hospital paediatrics

“…King et al conducted a systematic review of interventions aimed at reducing medication errors during inpatient rounds in children’s hospitals 1. Medication errors in hospitals may arise at many points in a complicated cascade of steps before reaching the patient; from prescribing, dispensing, distributing, administering, to monitoring.…”

Impact of clinical pharmacist-led intervention for drug-related problems in neonatal intensive care unit a randomized controlled trial

“…Although there are many reports on how and to what extent clinical pharmacists ensured drug safety and reported DRPs in the NICU since the 1980s, we are not aware of a randomized clinical trial (RCT) exploring and quantifying the effect of a clinical pharmacist intervention in the NICU setting ( Campino et al, 2008 ; Palmero et al, 2019 ; King et al, 2023 ). Therefore, the objective of this RCT was to determine whether a clinical pharmacist intervention improves medication safety and prevents DRPs (MEs, ADRs, and DDIs) in neonates admitted to the NICU.…”