Objectives To identify the incidence and nature of paediatric prescribing errors at the discharge stage, to investigate if factors such as grade of prescriber, age and ward speciality may affect the incidence of prescribing errors and to recommend strategies to minimise the prescribing error rate at discharge.
Method Data collection took place at a large teaching hospital providing tertiary paediatric care, on six paediatric wards (general, liver, neurology, surgical and intensive care and high dependency unit) and one neonatal ward. Data collection was carried out over a three week period during the months of March and April 2013. Data was collected both prospectively and retrospectively; prospective data collection was carried out by pharmacists during their routine ward rounds. Retrospective data collection was carried out by the investigator. To Take Aways (TTAs) booked into the pharmacy the previous day were identified through the Patient Tracking System (PTS). Data collected during routine working hours, Monday to Friday, was included in this study. Data was also collected on Drug lists (discharge notifications ordered by pharmacists). Discharge notifications were predominately prescribed using an Electronic Prescribing System. Only 1 out of 109 discharge notifications was handwritten.
Results A total of 84 TTAs containing 395 medication orders were identified. On average each TTA contained 5 medication orders and in total, 43 of the 395 medication orders contained prescribing errors. A 10.9% prescribing error rate was calculated. Approximately 28.5% of TTA had one error or more. Omission of medication was the most frequently encountered error, contributing to 34.8% of all prescribing errors followed by incorrect/missing administration time (11.6%) and incorrect/missing CD requirements (11.6%). Anticonvulsants and antibiotics were the most commonly implicated drugs.
PICU/HDU presented a 100% prescribing error rate. However, only one TTA was prescribed on this ward. From the remaining wards, the neurology ward had the highest prescribing error rate (17.5%).
Prescribing error rates between different grade of prescribers and age groups were also investigated. Senior doctors were found to contribute most to prescribing errors (69%) although were responsible for 51% of all medication orders. The prescribing error rate between age groups is of similar incidence, although the highest prescribing error rate was recorded for neonates.
In addition, 25 drug lists were also documented containing 162 medication orders. Only 1 prescribing error was identified on all drug lists giving a prescribing pharmacist error rate of 0.6%.
Conclusion Though prescribing errors in paediatric hospital settings are prevalent, limited literature is available on the incidence of paediatric prescribing errors at the discharge stage. The incidence of prescribing errors identified on the paediatric and neonatal wards at discharge is relatively high. Recommendations to help reduce prescribing errors such as periodical assessment, regular audits and the use of a training program to highlight issues surrounding prescribing errors at discharge have been proposed. Other recommendations such as improving aspects of the electronic prescribing system have also been suggested. Further research is required and on a larger scale to investigate paediatric prescribing errors at the discharge stage.
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