Interventions to Reduce Pediatric Prescribing Errors in Professional Healthcare Settings: A Systematic Review of the Last Decade

Koeck, Joachim Andreas; Young, N.J.; Kontny, Udo; Orlikowsky, Thorsten; Bassler, Dirk; Eisert, Albrecht

doi:10.1007/s40272-021-00450-6

Cited by 8 publications

(22 citation statements)

References 105 publications

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“…The overall error rate decreased signi cantly after implementation of the CPOE. This nding complies with the results of a recent systematic review in pediatrics by Koeck et al [9], indicating that CPOE reduces prescribing errors.…”

Section: Discussionsupporting

confidence: 91%

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Prescribing errors in children: What is the impact of a computerized physician order entry?

Satir

Pfiffner

Meier

et al. 2022

Preprint

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Purpose: Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children’s Hospital Zurich. Methods: We performed medication review on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index) as well as the interrater reliability (Cohen’s Kappa) were analyzed. Results: CPOE significantly reduced the rate of errors from 25 errors / 100 prescriptions (95% CI: 23 – 27) to 16 errors / 100 prescriptions (95% CI 14 – 18). Particularly the prescribing quality was improved by reducing PCNE error 5.2 “lacking information” (e.g. lacking drug form or maximum possible number of doses for reserve medication). Medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not statistically significantly altered after introduction of the CPOE. Overall severity of errors was reduced. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusions: The CPOE increases patient safety by reducing the rate and severity of prescribing errors. The reason for the observed increase in medication reconciliation problems might be the hybrid-system with remaining paper-prescriptions for special medication. The lacking effect on dosing errors might be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions on how to increase the usability of the CPOE, and full integration of CDS tools such as automated dose check into the CPOE.

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Section: Discussionsupporting

confidence: 91%

“…Computerized physician order entry (CPOE) seems to reduce prescribing errors [8][9][10], and overall evidence suggests that mortality rates and preventable adverse drug events are reduced by electronic prescribing [10].…”

Section: Introductionmentioning

confidence: 99%

Prescribing errors in children: What is the impact of a computerized physician order entry?

Satir

Pfiffner

Meier

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…In general, studies about medication errors show a great heterogeneity in definitions and methods [3,8,13]. To gain useful insights, clear definitions of the studied errors should be stated, validated error classifications applied, and-in addition to the prevalence of errors-severity of harm should be assessed [4,9,14,15]. Chart review rather than voluntary reporting should be used as data source [3,13], and interrater reliability should be calculated [13].…”

Section: Introductionmentioning

confidence: 99%

Prescribing errors in children: what is the impact of a computerized physician order entry?

et al. 2023

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Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children’s Hospital Zurich. We performed medication reviews on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index), as well as the interrater reliability (Cohen’s kappa), were analyzed. Potentially harmful errors were significantly reduced from 18 errors/100 prescriptions (95% CI: 17–20) to 11 errors/100 prescriptions (95% CI: 9–12) after CPOE implementation. A large number of errors with low potential for harm (e.g., “missing information”) was reduced after the introduction of the CPOE, and consequently, the overall severity of potential harm increased post-CPOE. Despite general error rate reduction, medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after the introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not altered on a statistically significant level after the introduction of the CPOE. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusion: Patient safety increased by reducing the rate of prescribing errors after CPOE implementation. The reason for the observed increase in medication reconciliation problems might be the hybrid system with remaining paper prescriptions for special medication. The lacking effect on dosing errors could be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before the implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions to increase the usability of the CPOE, and full integration of CDS tools such as automated dose checks into the CPOE. What is Known: • Prescribing errors, especially dosing errors, are a common safety threat for pediatric inpatients. •The introduction of a CPOE may reduce prescribing errors, though pediatric general wards are poorly studied. What is New: •To our knowledge, this is the first study on prescribing errors in pediatric general wards in Switzerland investigating the impact of a CPOE. •We found that the overall error rate was significantly reduced after the implementation of the CPOE. The severity of potential harm was higher in the post-CPOE period, which implies that low-severity errors were substantially reduced after CPOE implementation. Dosing errors were not reduced, but missing information errors and drug selection errors were reduced. On the other hand, medication reconciliation problems increased.

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“…Implementation of such an ancillary system can actively engage remote pharmacists in collaborating with primary care physicians in identifying and implementing preventative medication strategies. Thus, such a system may serve as an important aspect of rational drug therapy ( 17 ). The application of this system is still in its early stage.…”

Section: Introductionmentioning

confidence: 99%

A Survey of Prescription Errors in Paediatric Outpatients in Multi-Primary Care Settings: The Implementation of an Electronic Pre-Prescription System

Tan

Chen

et al. 2022

Front. Pediatr.

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BackgroundPrescription errors impact the safety and efficacy of therapy and are considered to have a higher impact on paediatric populations. Nevertheless, information in paediatrics is still lacking, particularly in primary care settings. There exists a need to investigate the prevalence and characteristics of prescription errors in paediatric outpatients to prevent such errors during the prescription stage.MethodsA cross-sectional study to evaluate paediatric prescription errors in multi-primary care settings was conducted between August 2019 and July 2021. Prescriptions documented within the electronic pre-prescription system were automatically reviewed by the system and then, potentially inappropriate prescriptions would be reconciled by remote pharmacists via a regional pharmacy information exchange network. The demographics of paediatric patients, prescription details, and types/rates of errors were assessed and used to identify associated factors for prescription using logistic regression.ResultsA total of 39,754 outpatient paediatric prescriptions in 13 community health care centres were reviewed, among which 1,724 prescriptions (4.3%) were enrolled in the study as they met the inclusion criteria. Dose errors were the most prevalent (27%), with the predominance of underdosing (69%). They were followed by errors in selection without specified indications (24.5%), incompatibility (12.4%), and frequency errors (9.9%). Among critical errors were drug duplication (8.7%), contraindication (.9%), and drug interaction (.8%) that directly affect the drug's safety and efficacy. Notably, error rates were highest in medications for respiratory system drugs (50.5%), antibiotics (27.3%), and Chinese traditional medicine (12.3%). Results of logistic regression revealed that specific drug classification (antitussives, expectorants and mucolytic agents, anti-infective agents), patient age (<6 years), and prescriber specialty (paediatrics) related positively to errors.ConclusionOur study provides the prevalence and characteristics of prescription errors of paediatric outpatients in community settings based on an electronic pre-prescription system. Errors in dose calculations and medications commonly prescribed in primary care settings, such as respiratory system drugs, antibiotics, and Chinese traditional medicine, are certainly to be aware of. These results highlight an essential requirement to update the rules of prescriptions in the pre-prescription system to facilitate the delivery of excellent therapeutic outcomes.

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Interventions to Reduce Pediatric Prescribing Errors in Professional Healthcare Settings: A Systematic Review of the Last Decade

Cited by 8 publications

References 105 publications

Prescribing errors in children: What is the impact of a computerized physician order entry?

Prescribing errors in children: What is the impact of a computerized physician order entry?

Prescribing errors in children: what is the impact of a computerized physician order entry?

A Survey of Prescription Errors in Paediatric Outpatients in Multi-Primary Care Settings: The Implementation of an Electronic Pre-Prescription System

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