Background The complex nature of paediatric prescribing makes this population more vulnerable to medication errors.1Electronic Prescribing and Medicines Administration Systems (EPMASs) have been suggested to improve paediatric medication safety by reducing prescribing errors.
Aim To identify and compare the number and nature of paediatric medication errors pre and post introduction of an EPMAS at a tertiary paediatric hospital.
Methodology Pharmacists collected data monthly on the number of new items prescribed and the number of errors (if any) detected in these prescriptions following methodology from the EQUIP study.2 The EPMAS Meditechv6 was introduced in June 2015. Data analysed included forms from 1st-January-2015 to 30th-June-2015 (period 1: pre-EPMAS) and 1st-January-2016 to 30th-June-2016 (period 2: post-EPMAS). The analysis aimed to investigate the rate, type and severity of errors as well as the prescriber grade, prescribing stage and drug class associated with each. Descriptive statistical methods were used to analyse the frequency and nature of errors pre and post implementation of Meditech. Statistical significance was tested using a contingency Chi-squared (χ2) test for the difference in error rates across both periods and a Mann-Whitney test for the difference between the severities of errors across both periods
Results An increase of 6.4% in error rate was detected post-Meditech introduction with 67 errors in 1706 items (3.9%) during period 1 and 151 errors in 1459 items (10.3%) during period 2 (p<0.001, χ2 test). FY2 doctors and ‘admission stage’ were associated with the highest error rates across both periods. Minor severity errors were the most common in both periods, with 55.2% in period 1% and 66.2% in period 2. No statistical difference was detected (p=0.403) in the severity of errors reported although the proportion of significant and serious errors decreased from 38.8% to 27.8% and 6.0% to 0.7% respectively. No errors were classed to be potentially lethal in period 1, however there was one such incident in period 2. Underdosing was the most common error type in period 1 (22.4%), falling to 4.0% in period 2. Omission on admission was the most common error type in period 2, with an error rate of 37.7% vs 20.9% in period 1. Antibacterials and analgesics were the most common classes of drugs involved in errors in both periods, although a wider range of drug classes were involved in errors post Meditech introduction
Conclusion A significant increase of 6.4% in error rate was found post implementation of Meditech highlighting the concept of EPMAS-facilitated errors. The positive effect of EPMASs is also apparent as the incidence of significant and serious errors decreased in period 2, although this difference was not statistically significant. Reaching definitive conclusions is difficult due to the lack of available research into the effects of EPMASs on paediatric prescribing and due to methodological limitations. However, it can be suggested that introducing functions such as comprehensive decision support and dose calculators may overcome the shortcomings of the current system3 and allow for the true benefits of EPMASs in improving paediatric medication safety to be demonstrated.
National Patient Safety Agency. Review of patient safety for children and young people 2009. England: National Reporting and Learning Services. http://www.nrls.npsa.nhs.uk/resources/?entryid45=5986 [Accessed: 29th October 2016].
Dornan T, et al. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. Final Report to the General Medical Council 2009. http://www.gmcuk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf [Accessed: 9th November 2016].
Johnson KB, Lehmann CU. Electronic prescribing in paediatrics: Toward safer and more effective medication management. Paediatrics 2013;131(4):e1350–e1356. doi:10.1542/peds.2013-0193
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