Introduction of a prescribing ward round to reduce prescribing errors on a paediatric intensive care unit

Abstract

<jats:p>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.</jats:p>

Developing a climate for safe prescribing for children

“…In a different approach, some centres have integrated prescribing as a part of ward rounds or introduced specific prescribing ward rounds. 4 Interventions such as these are welcome because they respond directly to evidence about why errors happen. Yet they may work in complex ways, not simply by reducing distractions; instead they may 'make prescribing everyone's business', improve access to senior support for prescribing decisions, and reduce non-urgent prescribing outof-hours.…”

“…As well as reducing distractions, these areas may also support prescribers by making essential resources readily available. In a different approach, some centres have integrated prescribing as a part of ward rounds or introduced specific prescribing ward rounds 4. Interventions such as these are welcome because they respond directly to evidence about why errors happen.…”

“…by elucidating factors that complicate prescribing for children 3 ), and prioritised within policy, quality improvement and education. 1 Instances of successful and innovative interventions 4 have been published, but prescribing safety remains elusive. 5 This begs these questions: should we look at the problem differently?…”

“…Prescribing error—a foremost threat to paediatric safety1—has been studied (eg, multicentre research quantifying prevalence and types),2 clarified (eg, by elucidating factors that complicate prescribing for children)3 and prioritised within policy, quality improvement and education 1. Instances of successful and innovative interventions4 have been published, but prescribing safety remains elusive 5. This begs these questions: Should we look at the problem differently?…”

The effect of a decision support system on the incidence of prescription errors in a PICU

“…Electronic prescribing alone does not actively prevent the prescription of an incorrect drug, dose or frequency. 2,14,15 The addition of clinical decision support systems (CDSS) to CPOE systems has been found to reduce prescription error rates more significantly. 2 CDSS is a technological intervention that targets the ordering stage of medications, where approximately half of all medication errors occur.…”