Background Prescribing errors have the potential to adversely affect the safe pharmacological treatment of patients of all ages. The multi-centre General Medical Council commissioned ‘EQUIP’ study assessed the prevalence and nature of prescribing errors and found a mean rate of errors in 8.9% of medication orders.1 Paediatric data was not however analysed separately. Errors have been estimated to cause harm in paediatric patients three times more often than in adults.2 Clinical pharmacists play a role in identifying prescribing errors and minimising harm but this role has not been explored in detail in children in the UK.
Objectives To evaluate the prevalence and nature of prescribing errors and the role of hospital pharmacists in identifying and reducing risk in neonatal and paediatric patients.
Methods Data collection sites were identified through the Neonatal and Paediatric Pharmacists Group by an email asking for volunteer centres. Clinical pharmacists working in these hospitals were asked to document prescribing errors in inpatient medication orders identified as part of their routine practice using a data collection form adapted from the EQUIP study1. A variety of hospital settings were aimed for.
Data was collected monthly on six separate weekdays in most of the participating hospitals in 2013. Data was entered on to a SPSS database for collation and analysis.
Classification of error type and potential severity was done using the EQUIP study categories1. Drugs were categorised according to the British National Formulary for Children3 and patient's ages were grouped according to the International Conference of Harmonisation guidelines.4
Results Thirteen hospitals (eight specialist children's and five general teaching hospitals) from across the UK agreed to participate. Pharmacists checked 11,941 prescriptions written for 3,330 patients and identified 1,039 errors: an overall rate of 8.7% of medication orders with 20.6% of all patients having a prescribing error.
Overdose was found to be the most common error followed by incorrect or missing administration times and underdose. This was in contrast to the EQUIP study where omission errors were most common. Specialist trainees/trust grade fixed term specialty training appointments (FTSTAs) made the majority of errors; however this was in proportion with the number of prescriptions which they wrote. Antibacterial and analgesic drugs were the most common classes associated with errors and the oral route was the most common route involved.
70% errors were classified as minor, though 25% were considered significant, 5.4% serious and 0.22% (two errors) potentially lethal. Five patients were stated to have experienced harm.
39.6% of errors occurred during the patient's hospital stay followed by 35% errors occurring on admission.
Conclusion Prescribing errors occurred at a similar rate as in adult patients 1 but the most common type of errors was different with dosing errors most common in children. Clinical pharmacists' interventions play an important role in identifying and minimising harm from prescribing errors.
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