Objective To compare the rate, nature and clinical significance of prescribing errors, before and after the introduction of electronic prescribing, in neonates and children.
Methods The study was conducted at a large teaching hospital comprising, national tertiary and local paediatric services. Prescribing errors were prospectively identified over a two week period (excluding weekends) on six paediatric and one neonatal ward. The errors were then recorded and classified1 on ward visits and consultant led ward rounds. The clinical significance was measured using a validated, reliable method.2 Four health professionals, experienced in paediatrics scored each error on a scale of 1–10. A mean was then taken of the score and the value was used as an indication of the severity. Data were collated and analysed using Microsoft Excel. Data were collected in this way both during the pre-electronic (paper-based) prescribing period (January 2012) and the post-electronic prescribing period (March 2013). The results from each audit were then compared to ascertain the impact of the electronic prescribing system.
Results A total of 2,264 medication orders were written during the study period (4 weeks total, 2 weeks before and 2 weeks after). Prescribing errors were identified in 275 prescriptions. Before the implementation of the electronic prescribing system there were 1117 medication orders of which 95 contained prescribing errors (8.5%). 18.6% of the errors were considered to be of minor clinical significance, 80.4% had a moderate outcome and 1% had a potentially severe outcome. After the introduction of the electronic prescribing system, there were 1147 medication orders of which 180 contained prescribing errors (15.7%). 26.6% of the errors were considered to have minor outcome and 73.4% were considered to have a moderate outcome. None of the prescribing errors intercepted during the post-EP period were considered to have a severe outcome. The ward area with the highest error rate was paediatric critical care (40%). Morphine was the drug associated with the highest number of errors. The most common type of error was continuation of a prescription for longer than necessary. A number of errors were eliminated completely by the introduction of electronic prescribing.
Conclusions There was an increase in the prescribing error rate after the introduction of an electronic prescribing system however the nature of the errors had changed. The clinical significance of the errors remained approximately the same. A large multi-centre study is required to confidently assess the impact of electronic prescribing on the rate, nature and clinical significance of prescribing errors in neonates and children.