Aim To identify the nature, frequency and incidence of prescribing errors on a PICU.
Method Electronic intervention data was collected over a two-week period for all patients admitted to or currently on the PICU. A purposefully designed electronic data collection form was developed using Microsoft Excel and piloted by the researchers in advance of commencing the audit to ensure fitness for use. Data was collected in the moment and retrospectively as outlined below. A daily patient list was generated, and the following information extracted from the patient’s medication chart; total number of items prescribed each day and the proportion of those that were new. Only patients present in the unit were included in the data collection. Pharmacist interventions are recorded electronically each day. The numbers of interventions reported daily for the study were collected retrospectively from the pharmacy intervention system. The route of administration, type of error, drug, category of harm and prescriber identity to ascertain which shift the error occurred on were also extracted.
Results PICU did not operate at full capacity (24 beds) during the audit period, overall data for 39 patients was captured. Patients ranged from 0 to 15 years of age and had been admitted to the unit for a variety of surgical, medical and trauma-related reasons. A total of 36 interventions were reported giving an intervention rate of 92% per patient and 2.3% per number of prescriptions reviewed. The number of interventions appeared to correlate with the number of items prescribed (none of the prescriptions with 15 or less items required intervention). Many patients within the unit are nil-by-mouth and 77.5% (n=31) of the interventions reported were associated with medicines prescribed via the intravenous route with intravenous antibiotics accounting for 52.5% (n=21) of the total interventions reported. Most errors occurred during a long day shift and were near misses that did not reach the patient.
Conclusion The results show that the incidence of prescribing errors per patient was high but per number of prescriptions this is lower than comparable studies.1 Prescribing errors were most common for antimicrobial and intravenous medication and therefore these should be the focus of future reforms. The next steps will include a multidisciplinary team meeting to identify potential causes of error and solutions to overcome these. These are likely to reflect those reported in the literature such as raising awareness of errors, educational prescribing sessions, introduction of prescribing prompts, and a new system approach such as electronic medicines administration and prescribing systems, all of which have proven efficacious in reducing prescribing errors on PICUs.2 In order to implement and determine the impact of any changes a quality improvement approach of plan-do-study-act cycles will be adopted.3 This will help us meet the Trust target of a 20% reduction in errors.
Manias E, Kinney S, Cranswick N, et al. Interventions to reduce medication errors in pediatric intensive care. Ann Pharmacother 2014;48:1313-31.
Davey A, Britland A, Naylor R. Decreasing paediatric prescribing errors in a district general hospital. Qual Saf Health Care 2008;17:146.
Donnelly P, Lawson S, Watterson C. Improving paediatric prescribing practice in a district general hospital through implementation of a quality improvement programme. BMJ Open Qual 2015;4:u206996. w3769.
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