Aim To develop a prescribing application for use in paediatric critical care (PCCU) to reduce prescribing and administration errors.
Method A review by the Patient Safety Research Programme found that electronic prescribing (EP) is the most common and potentially the most beneficial intervention used to reduce prescribing errors.1 PCCU is a high risk area for medication errors and EP has been shown to reduce prescribing errors in this specialty.2 ,3 However many systems are limited by high cost, lack of paediatric dose calculations and appropriate decision support. They can also introduce new errors e.g. from (mis) selection.2 A software application (Prescribe4) was developed locally by a consultant Paediatric Intensivist with a drug formulary developed and validated by two PCCU clinical pharmacists. Prescribe4 calculates drug dosage and administration information, based on age and weight, for the most commonly used drugs in the PCCU presenting prescribing information along with decision support in the form of messages, algorithms and guidelines. The software generates self adhesive waterproof labels to attach to the paper drug card to reduce transcribing errors. Safety features were added to the software including feedback for weights that lie outside the 3rd to 97th centiles for age, restricting display to drug doses and regimens appropriate for the child.
Results A software application was created that is a CE marked Class 1 medical device that works on the Apple iPad™. The application has a comprehensive set of safety features to aid safe paediatric prescribing. The application also provides administration support for nurses, for example drug volumes, diluents, concentrations, rates of infusion, appropriate administration route appear on the prescribing label. Conclusion: EP reduces medication errors although the clinical impact of this, particularly in paediatrics requires further investigation. An EP application was developed and validated locally to meet the needs of EP for paediatric patients with the aim of reducing medication errors in PCCU patients. Evaluation of the software will be completed with a post introduction audit of medication error and pharmacist intervention rates. There is the potential for Prescribe4 to be used in other clinical areas/Trusts as the formulary, labels and supporting information can be tailored to meet local needs.