Elsevier

The Journal of Pediatrics

Volume 152, Issue 2, February 2008, Pages 214-218
The Journal of Pediatrics

Original article
Electronic Prescribing Reduced Prescribing Errors in a Pediatric Renal Outpatient Clinic

https://doi.org/10.1016/j.jpeds.2007.09.046Get rights and content

Objective

To assess the effect of an electronic prescribing (EP) system on the incidence and type of prescribing errors and the number of error-free visits.

Study design

This was a before-and-after study conducted in a nephrology outpatient clinic at an acute tertiary care pediatric hospital.

Results

A total of 520 patients had 2242 items prescribed on 1141 prescriptions during the study period. The overall prescribing error rate was 77.4% (95% confidence interval [CI] = 75.3% to 79.4%) for handwritten items and 4.8% (95% CI = 3.4% to 6.7%) with EP. Before EP, 1153 (73.3%; 95% CI = 71.1% to 75.4%) items were missing essential information, and 194 (12.3%; 95% CI = 10.8% to 14%) were judged illegible. After EP, only 9 (1.4%; 95% CI = 0.7% to 2.6%) items were missing essential information, and illegibility errors were eliminated. The number of patient visits that were error-free increased from 21% to 90% (69% difference; 95% CI = 64% to 73.4%) after the implementation of EP.

Conclusions

There was a high incidence of errors using handwritten prescriptions in the outpatient setting, with an overall error rate of 77.4%. EP significantly reduced errors related to completeness of prescriptions and eliminated legibility related errors.

Section snippets

Study Site

This study was conducted at an acute tertiary care pediatric hospital during implementation of a commercially available EP system (JAC Computer Services Ltd), which was introduced in the pediatric nephrology outpatient clinic on March 16, 2006, starting with 1 nephrology consultant and gradually rolling out to include all nephrology teams. We prospectively collected pediatric nephrology outpatient clinic prescriptions, which were evaluated at a later date for errors. All patients attending the

Results

A total of 520 patients had 2242 items prescribed on 1141 prescriptions during the study period. Of these, 8 prescriptions, involving 20 prescribed items, were excluded from analysis due to incomplete information. Patient demographic data are given in Table I.

There was good agreement between the 2 researchers for error identification (κ = 0.65; 95% confidence interval [CI] = 0.46 to 0.85). The overall prescribing error rate was 77.4% (95% CI = 75.3% to 79.4%) for handwritten items and 4.8% (95%

Discussion

EP significantly reduced overall prescribing error rates and resulted in a corresponding increase in the number of patient visits that were error-free. Dosing errors are typically considered the most common type of errors in pediatrics.17 In our study, however, omission errors (particularly those involving route of administration) were more frequent. This may be attributed to the design of the original prescription form. There was a combined prompt for the dose and route (ie, “dose/route”);

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  • Cited by (0)

    1

    Y.J. receives funding for a PhD studentship from Great Ormond Street Hospital for Children, First Databank Europe Ltd, and JAC Computer Systems Ltd. These companies did not contribute to study design; the collection, analysis or interpretation of the data; or writing the manuscript or the decision to submit it for publication.

    2

    I.W. has received funding from the UK Medical Research Council and UK Department of Health in the research of medication errors and the use of technology in their reduction.

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