scholarly journals 1 Developing consensus on hospital prescribing indicators of potential harm for infants and children

2018 ◽  
Vol 103 (2) ◽  
pp. e2.1-e2
Author(s):  
Andy Fox
Keyword(s):  
Expert Panel ◽  
Clinical Decision ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Prescribing Indicators ◽  
Potential Harm ◽  
The Uk ◽  
Paediatric Prescribing

AimsTo develop a list of hospital based paediatric prescribing indicators that can be used to assess the impact of electronic prescribing or clinical decision support tools on paediatric prescribing errors.BackgroundMedication errors are a major cause for concern in the NHS. Prescribing is part of the medication use process and is a complex task requiring an understanding of medicines, disease processes, and patient parameters. Systematic reviews have reported that medication errors occur in as many as 50% of hospital admissions and prescribing error rates in the UK hospitals vary between 9% and 15%.Prescribing for children is further complicated by the need to take into account weight, altered physiology and pharmacokinetics. Prescribing error rates of 13.1% have been reported in children with a potentially greater impact due to the nature of the patients.Electronic prescribing (EP) while relatively uncommon in UK hospitals is an important tool in reducing prescribing errors. EP systems have been shown to have a positive impact on prescribing errors, however methodologies vary and the reduction in harm is rarely investigated. A standard tool to allow an evaluation of the harm reduction is desirable and currently does not exist for the paediatric setting.MethodsTwo rounds of an electronic consensus method (eDelphi) were carried out with 21 expert panellists from the UK. Panellists were asked to score each prescribing indicator for its likelihood of occurrence and severity of outcome should the error occur. The scores were combined to produce a risk score and a median score for each indicator calculated. The degree of consensus between panellists was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or higher was achieved and were in the high risk categories.ResultsAn expert panel consisting of 8 pharmacists and 13 paediatricians with a total of 437 years of clinical experience completed an exploratory round and two rounds of scoring. This identified 41 paediatric prescribing indicators with a high risk rating and greater than 80% consensus. The most common error type within the indicators was wrong dose (n=19) and the most common drug classes were antimicrobials (n=10) and cardiovascular (n=7).ConclusionsA set of 41 paediatric prescribing indicators describing potential harm for the hospital setting have been identified by an expert panel. The indicators provide a standardised method of evaluation of prescribing data on both paper and electronic systems. They can also be used to assess implementation of clinical decision support systems or other quality improvement initiatives.

P30 The effects of introducing electronic prescribing for paediatric chemotherapy using aria on prescribing error rates at a primary treatment centre

2018 ◽  
Vol 103 (2) ◽  
pp. e2.33-e2
Author(s):  
Peter Cook ◽  
Andy Fox
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Error Rate ◽  
Lymphoblastic Leukaemia ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Patient Specific ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Error Type ◽  
Before And After

IntroductionPrescribing of medication in children is a very complex process that involves an understanding of paediatric physiology, disease states, medication used and pharmacokinetics as well as patient specific details, their co-morbidities and their clinical condition. The most common medication errors have been identified as dosing, route of administration, and frequency of administration. Computerised provider order entry has been shown to reduce the number of prescribing errors related to chemotherapy as well as the likelihood of dose and calculation errors in paediatric chemotherapy prescribing. Locally, paediatric chemotherapy is prescribed on pre-printed paper prescriptions. Adaptation and implementation of ARIA electronic prescribing (EP) system for use in paediatric chemotherapy was undertaken by a Specialist Paediatric Oncology Pharmacist and was rolled out for use in January 2016 for patients with acute lymphoblastic leukaemia.MethodThe United Kingdom National Randomised Trial for Children and Young Adults with Acute Lymphoblastic Leukaemia and Lymphoma 2011 (UKALL, 2011) was developed for use on EP, with prescribing of all other chemotherapy remaining on paper. The number and type of prescribing errors were collected during a pre-implementation phase from January 2015 to June 2015. After the introduction of EP and following a 2 month acclimatisation period, a second period of data collection took place between March 2016 and July 2016. Overall prescribing error rates and the frequency of each error type were calculated both before and after implementation.ResultsBefore the introduction of EP for paediatric chemotherapy, the overall error rate was 18.4% with a total of 16 different errors seen. Post implementation, overall error rate increased to 25.7% (p<0.001) with a total of 10 different errors seen. After introduction of EP, prescribing error rates on paper were 30.6% and on EP were 7.0% (p<0.001). Only 5 different error types were seen with electronic prescribing. The most commonly seen errors in prescribing with paper, both before and after were almost eliminated with the introduction of EP.ConclusionThe introduction of EP has resulted in a significant reduction in prescribing error rates compared to paper based prescribing for paediatric chemotherapy. Overall the prescribing error rate increased after the introduction of EP but this was related to an increased rate on the paper prescriptions. One possible reason for this was the use of dual systems for prescribing. In addition there was unforeseen relocation and building work within the paediatric cancer unit, which affected prescribing time allocation. There were also several staff shortages within the prescribing team after implementation and this resulted in an increased workload on the remaining chemotherapy prescribers. All these issues could have attributed to the increase in error rates. The most common errors seen with chemotherapy prescribing have been reduced with EP as protocols have been developed with a focus on prescribing safety. Further work is needed as more prescribing takes place on EP to assess the full impact it has on paediatric chemotherapy error rates.

Electronic prescribing in paediatric secondary care: are harmful errors prevented?

2019 ◽  
Vol 104 (9) ◽  
pp. 895-899 ◽  
Author(s):  
Andy Fox ◽  
Jane Portlock ◽  
David Brown
Keyword(s):  
Decision Support ◽  
Outcome Measures ◽  
Clinical Decision Support ◽  
Secondary Care ◽  
Clinical Decision ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Set Up ◽  
Paediatric Prescribing

ObjectiveThe aim of this research was to ascertain the effectiveness of current electronic prescribing (EP) systems to prevent a standardised set of paediatric prescribing errors likely to cause harm if they reach the patient.DesignSemistructured survey.SettingUK hospitals using EP in the paediatric setting.Outcome measuresNumber and type of erroneous orders able to be prescribed, and the level of clinical decision support (CDS) provided during the prescribing process.Results90.7% of the erroneous orders were able to be prescribed across the seven different EP systems tested. Levels of CDS varied between systems and between sites using the same system.ConclusionsEP systems vary in their ability to prevent harmful prescribing errors in the hospital paediatric setting. Differences also occur between sites using the same system, highlighting the importance of how a system is set up and optimised.

SP3 The effect of electronic prescribing and medicines administration systems (epmass) on paediatric medication errors

2018 ◽  
Vol 103 (2) ◽  
pp. e1.23-e1
Author(s):  
Aragon Octavio ◽  
Fayyaz Goher ◽  
Gill Andrea ◽  
Morecroft Charles
Keyword(s):  
Medication Errors ◽  
Error Rate ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Error Type ◽  
Common Error ◽  
Period 2 ◽  
The Difference ◽  
Paediatric Prescribing

BackgroundThe 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.AimTo identify and compare the number and nature of paediatric medication errors pre and post introduction of an EPMAS at a tertiary paediatric hospital.MethodologyPharmacists 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 periodsResultsAn 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 introductionConclusionA 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.ReferencesNational 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

scholarly journals P029 Audit of aciclovir prescribing to assess whether changing the order of drop down box options in an electronic prescribing system can reduce prescribing errors

2019 ◽  
Vol 104 (7) ◽  
pp. e2.33-e2
Author(s):  
Clarissa Gunning ◽  
Jennifer Gray
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Improve Patient Safety ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Contributory Factor ◽  
List Type ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Dosing Error

AimIn 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.MethodsThe 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.ResultsDosing 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.ConclusionThese 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.ReferenceAhmed 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.

ASSESSING THE IMPACT OF A NEWLY INTRODUCED ELECTRONIC PRESCRIBING SYSTEM ACROSS A PAEDIATRIC DEPARTMENT – LESSONS LEARNED

2016 ◽  
Vol 101 (9) ◽  
pp. e2.13-e2 ◽  
Author(s):  
Anastasia Tsyben ◽  
Nigel Gooding ◽  
Wilf Kelsall
Keyword(s):  
Good Practice ◽  
Electronic System ◽  
Daily Basis ◽  
Error Rates ◽  
Lessons Learned ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
New Challenges ◽  
The Impact

AimPrescribing audits have shown that the Women's and Children's Directorate reported higher number of prescription errors on the paediatric and neonatal wards compared to other areas in the Trust. Over the last three years a multidisciplinary prescribing team (PT), which included senior clinicians, pharmacists and trainees introduced a number of initiatives to improve the quality of prescribing. Strategies included structured departmental inductions, setting up of designated prescribing areas and reviewing errors with the prescriber. Year on year there were fewer prescribing errors.1 With the introduction of a new electronic prescribing system in October 2014 prescribing error rates were expected to decrease further, eradicating omissions around allergy recording, ward location and drug names. The aim of this abstract is to highlight the impact of the new system and describe lessons learned.MethodIn the summer of 2014, all inpatient drug charts across the department were reviewed on three non-consecutive days over a period of three weeks. Prescribing errors were identified by the ward pharmacist. Errors were grouped according to type and further analyzed by the PT. Errors deemed to have no clinical significance were excluded. Error rates were compared to the previous audits performed with identical methodology. Following the introduction of the electronic prescribing system, the ward pharmacists continued to review prescription charts on daily basis and generate regular error reports to notify the staff of new challenges.ResultsThere were 174 (14%) errors out of 1225 prescriptions on 181 drug charts. The most commonly made mistakes included drug name errors, strength of preparation, allergies and ward documentation, prescriber's signature omissions, and antibiotic review and end dates. The introduction of an electronic system has eliminated drug name, strength of preparation, allergy recording and ward errors. However, serious challenges have been identified: entering of an incorrect weight resulted in all drug dosages being inaccurate; the timing of drug levels for Vancomycin and Gentamicin and the administration of subsequent doses have been problematic. Communication difficulties between all staff groups has led to dosage omission, duplicate administration and confusion around start and stop dates. The ability to prescribe away from the bedside and indeed the ward has compounded some of these problems.ConclusionThe implementation of a new electronic system has reduced prescribing errors but has also resulted in new challenges, some with significant patient safety implications. The lessons learned and good practice introduced following previous audits of “traditional paper based” prescribing are equally important with electronic prescribing. Communication between staff groups is crucial. It is likely that the full benefits of the system will be realized a year after its introduction. On-going audit is required to assess the impact and safety of the electronic prescribing and lessons learned.

INTERVENTIONS MADE BY UK PHARMACISTS TO MINIMISE RISK FROM PAEDIATRIC PRESCRIBING ERRORS

2016 ◽  
Vol 101 (9) ◽  
pp. e2.62-e2 ◽  
Author(s):  
Sattam Alenezi ◽  
Janine Abramson ◽  
Coral Smith ◽  
Helen Sammons ◽  
Sharon Conroy
Keyword(s):  
Data Collection ◽  
Routine Practice ◽  
Medical Council ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Error Type ◽  
Common Error ◽  
Clinical Pharmacists ◽  
Paediatric Patients ◽  
The Uk

BackgroundPrescribing errors have the potential to adversely affect the safe pharmacological treatment of patients of all ages. The multi-centre General Medical Council commissioned ‘EQUIP’ study assessed the prevalence and nature of prescribing errors and found a mean rate of errors in 8.9% of medication orders.1 Paediatric data was not however analysed separately. Errors have been estimated to cause harm in paediatric patients three times more often than in adults.2 Clinical pharmacists play a role in identifying prescribing errors and minimising harm but this role has not been explored in detail in children in the UK.ObjectivesTo evaluate the prevalence and nature of prescribing errors and the role of hospital pharmacists in identifying and reducing risk in neonatal and paediatric patients.MethodsData collection sites were identified through the Neonatal and Paediatric Pharmacists Group by an email asking for volunteer centres. Clinical pharmacists working in these hospitals were asked to document prescribing errors in inpatient medication orders identified as part of their routine practice using a data collection form adapted from the EQUIP study1. A variety of hospital settings were aimed for.Data was collected monthly on six separate weekdays in most of the participating hospitals in 2013. Data was entered on to a SPSS database for collation and analysis.Classification of error type and potential severity was done using the EQUIP study categories1. Drugs were categorised according to the British National Formulary for Children3 and patient's ages were grouped according to the International Conference of Harmonisation guidelines.4 ResultsThirteen hospitals (eight specialist children's and five general teaching hospitals) from across the UK agreed to participate. Pharmacists checked 11,941 prescriptions written for 3,330 patients and identified 1,039 errors: an overall rate of 8.7% of medication orders with 20.6% of all patients having a prescribing error.Overdose was found to be the most common error followed by incorrect or missing administration times and underdose. This was in contrast to the EQUIP study where omission errors were most common. Specialist trainees/trust grade fixed term specialty training appointments (FTSTAs) made the majority of errors; however this was in proportion with the number of prescriptions which they wrote. Antibacterial and analgesic drugs were the most common classes associated with errors and the oral route was the most common route involved.70% errors were classified as minor, though 25% were considered significant, 5.4% serious and 0.22% (two errors) potentially lethal. Five patients were stated to have experienced harm.39.6% of errors occurred during the patient's hospital stay followed by 35% errors occurring on admission.ConclusionPrescribing errors occurred at a similar rate as in adult patients 1 but the most common type of errors was different with dosing errors most common in children. Clinical pharmacists' interventions play an important role in identifying and minimising harm from prescribing errors.

scholarly journals P37 A model for reducing paediatric prescribing errors in secondary care

2020 ◽  
Vol 105 (9) ◽  
pp. e26.1-e26
Author(s):  
Kate Morgan
Keyword(s):  
Medication Errors ◽  
Error Rate ◽  
Neonatal Intensive Care ◽  
Inappropriate Medication ◽  
List Type ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Senior Nurse ◽  
Ward Rounds ◽  
Paediatric Prescribing

BackgroundA prescribing error is a preventable error that may lead to inappropriate medication use and patient harm(1). Prescribing errors are particularly important in paediatrics where dose calculations are complicated and small errors can result in significant morbidity and mortality.1 In 2017 pharmacy data showed that paediatric prescribing errors were an issue at our Hospital regarding the severity and high numbers of errors, especially for antibiotics and analgesia.ObjectivesTo achieve a zero prescribing error rate for paediatric within the hospital.MethodForm the Paediatric Medication Errors Prevention (PMEP) group consisting of the Paediatric Consultant, Paediatric Pharmacist, Children’s Assessment Unit Sister and Practice Education Senior Nurse.Paediatric Pharmacist to record and feedback all paediatric prescribing errors weekly at Doctors’ handover.Paediatric Pharmacist/Nurses to DATIX report all significant medication prescribing errorsPaediatric Pharmacist to produce and communicate monthly pharmacy prescribing newsletter.Paediatric Pharmacist to produce quick reference charts for the drugs with the most common prescribing errors e.g. antibiotics and analgesiaPaediatric Doctors to request a second check from another Doctor or Ward Sister when prescribing any medication on the drug chart of take home prescription.Paediatric Pharmacist to target Doctors’ induction to improve prescribing and implement a prescribing test.Doctors to complete reflections for errors with their educationsal supervisors.This study did not require ethics approval.ResultsFollowing implementation of the above strategies, there was a 33% reduction in the number of prescribing errors recorded by the Paediatric Pharmacist daily intervention log from 2017/2018 to 2018/2019. There were 163 prescribing errors for 2017/2018 compared to 110 for 2018/2019.ConclusionThe formation of the PMEP group and implementation of strategies to reduce paediatric prescribing errors has positively impacted on reducing the error rate at the hospital. It has also raised awareness of the necessity to report all errors and actively find ways to prevent these from re-occurring. Further work is required to reduce these errors to zero including targeting non paediatric teams prescribing on paediatrics and implementing Pharmacists prescribing on consultant ward rounds. Future work would also include replicating this model in other specialities e.g. neonatal intensive care to achieve the same success rate in reducing medication errors.ReferenceDavis T. Paediatric prescribing errors. Arch Dis Child. 2011;96:489–91. Accessed via http://adc.bmj.com on 2/4/19.

scholarly journals The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

2020 ◽  
Vol 11 (02) ◽  
pp. 323-335 ◽  
Author(s):  
Moninne M. Howlett ◽  
Eileen Butler ◽  
Karen M. Lavelle ◽  
Brian J. Cleary ◽  
Cormac V. Breatnach
Keyword(s):  
Intensive Care ◽  
New Technology ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Before And After ◽  
The Impact ◽  
Before And After Study

Abstract Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.

scholarly journals The impact of health information technology on prescribing errors in hospitals: a systematic review and behaviour change technique analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Joan Devin ◽  
Brian J. Cleary ◽  
Shane Cullinan
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Behaviour Change ◽  
Error Rates ◽  
Behaviour Change Techniques ◽  
Prescribing Errors ◽  
Order Entry ◽  
Prescribing Error ◽  
The Impact

Abstract Background Health information technology (HIT) is known to reduce prescribing errors but may also cause new types of technology-generated errors (TGE) related to data entry, duplicate prescribing, and prescriber alert fatigue. It is unclear which component behaviour change techniques (BCTs) contribute to the effectiveness of prescribing HIT implementations and optimisation. This study aimed to (i) quantitatively assess the HIT that reduces prescribing errors in hospitals and (ii) identify the BCTs associated with effective interventions. Methods Articles were identified using CINAHL, EMBASE, MEDLINE, and Web of Science to May 2020. Eligible studies compared prescribing HIT with paper-order entry and examined prescribing error rates. Studies were excluded if prescribing error rates could not be extracted, if HIT use was non-compulsory or designed for one class of medication. The Newcastle-Ottawa scale was used to assess study quality. The review was reported in accordance with the PRISMA and SWiM guidelines. Odds ratios (OR) with 95% confidence intervals (CI) were calculated across the studies. Descriptive statistics were used to summarise effect estimates. Two researchers examined studies for BCTs using a validated taxonomy. Effectiveness ratios (ER) were used to determine the potential impact of individual BCTs. Results Thirty-five studies of variable risk of bias and limited intervention reporting were included. TGE were identified in 31 studies. Compared with paper-order entry, prescribing HIT of varying sophistication was associated with decreased rates of prescribing errors (median OR 0.24, IQR 0.03–0.57). Ten BCTs were present in at least two successful interventions and may be effective components of prescribing HIT implementation and optimisation including prescriber involvement in system design, clinical colleagues as trainers, modification of HIT in response to feedback, direct observation of prescriber workflow, monitoring of electronic orders to detect errors, and system alerts that prompt the prescriber. Conclusions Prescribing HIT is associated with a reduction in prescribing errors in a variety of hospital settings. Poor reporting of intervention delivery and content limited the BCT analysis. More detailed reporting may have identified additional effective intervention components. Effective BCTs may be considered in the design and development of prescribing HIT and in the reporting and evaluation of future studies in this area.

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