The Paediatric High Dependency Unit (PHDU) at Chelsea and Westminster hospital admits around 500 children per year. In 2011 the service expanded allowing for up to 20 children per year to be ventilated post surgery. Continuous variable rate infusions are necessary to safely ventilate children. Electronic prescribing (EPR) has been in place for 3 years on the Paediatric wards. Use of EPR to reduce prescribing errors in a London Paediatric Intensive Care Unit (PICU) has recently been described in the medical literature.1
Objective Design a safe and effective method of prescribing medications via continuous variable rate infusions on PHDU. Ensure prescribing is compliant with current EPR application (Lastword).
Method Electronic screens were designed using the PHDU variable rate infusion prescribing guide, which was adopted from the Children's Acute Transport Service protocols.2 Screens were placed within a PHDU index in the paediatric formulary on Lastword to centralise the location of the screens and reduce the risk of incorrect drug selection. Screens display all relevant prescription information: patient demographics (including weight) amount of medication in syringe, diluent, total volume of syringe, infusion rate and dose range. To reduce prescribing errors the recommended dose ranges were defaulted into those medication screens deemed the highest risk. The frequency for all infusions was defaulted to ‘every 24 h’, ensuring that new prescriptions were automatically scheduled each day, and that they could be reviewed regularly. Training was provided to all the pharmacy and PHDU staff.
Results EPR screens were designed on Lastword in order to hold key prescribing information. Use of default doses prompted doctors of the recommended doses of each infusion, which were used in conjunction with PHDU prescribing guide. Use of a specialty index allows segregation of the screens, reducing the risk of mis-selection of drug by prescribers. Hourly recording of infusion rates could not be completed electronically. This information was recorded on the patient's paper continuous monitoring sheet.
Conclusion To date, the electronic screens have been used successfully for a small number of test patients, the full impact on patient care and prescribing errors will be evaluated next year. The design of the screens allows for all prescription details to be shown electronically, with the advantage of reducing the risk of having two systems in place (eg, Carevue or paper) and allowing for recommended dose ranges to be defaulted. The main disadvantage of EPR was that hourly rates of infusion could not be recorded electronically and infusion rates had to be calculated manually. EPR is used on many paediatric wards across the UK however there is currently only one PICU using it. The authors hope to have designed a safe and practical way to prescribe variable rate infusions electronically, the concept of which can be shared with other units.