Aim In December 2016 it was identified that there had been multiple reports of prescribing errors with intravenous aciclovir on the paediatric intensive care unit (PICU). After investigation it was concluded that prescribers choosing incorrectly from a drop down menu of drug and dosing options on the electronic prescribing (EP) system was the main contributory factor. From 01/02/17 the aciclovir drop down options were prioritised, with the most frequently used option appearing first, to encourage prescribers to pick the correct regimen.

Methods The trust has been using the Phillips ICCA EP system across all intensive care units since 2016. Picking errors when prescribing are known to be a potential risk within EP systems, however tailoring these systems to guide choice also has the potential to improve patient safety by reducing the risk of prescribing errors.¹ Aciclovir has a complex range of dosing recommendations, especially in paediatrics, and incorrect prescribing increases the likelihood of subtherapeutic treatment or adverse effects. The aim of this audit is to assess whether changing the order of prescription choices on the drop down menu in the EP system reduced prescribing error rates for intravenous aciclovir. All prescriptions for aciclovir on PICU were identified during the 6 months before and after implementing the change, from 01/08/16 to 31/07/17. 65 prescriptions were included in the audit and were reviewed retrospectively using the EP system and electronic medical notes to assess whether the prescribed aciclovir dose and route was correct for the patient’s age, weight and indication as well as whether the appropriate drop down option had been selected by the prescriber. Dosing was assessed against recommendations in the British National Formulary for children and trust empirical antibiotic guidelines.

Results Dosing errors were found in 22% (14/65) of prescriptions overall during the review period. Before the change was implemented 26% (9/35) of aciclovir prescription doses were incorrect, reducing to 17% (5/30) after the change. The overall dosing error rate was 14% (7/50) in prescriptions where the correct drop down option was chosen, in comparison to 47% (7/15) in cases where the wrong option had been selected, suggesting the importance of choosing the correct pre-set option to minimise prescribing error rates. In cases where doses were incorrect, the prescriber had chosen the incorrect pre-set drop down option for the patient’s age and indication in 78% (7/9) of prescriptions before the order change compared to 0% (0/5) afterwards.

Conclusion These results suggest that prescribing error rates were reduced after making alterations to the order of prescription choices on the drop down menu in the EP system and that prioritising the order of these options may positively influence prescribing. Errors were not completely eliminated suggesting more work is required to further minimise risk.

Reference

1. Ahmed Z, Garfield S, Jani Y, et al. Impact of electronic prescribing on patient safety in hospitals: implications for the UK. Pharm J 2016;8:1–11.