Appl Clin Inform 2020; 11(02): 323-335
DOI: 10.1055/s-0040-1709508
Research Article
Georg Thieme Verlag KG Stuttgart · New York

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

Moninne M. Howlett
1  Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
2  School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
3  National Children's Research Centre, Crumlin, Dublin, Ireland
,
Eileen Butler
1  Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
,
Karen M. Lavelle
1  Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
,
Brian J. Cleary
2  School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
4  Department of Pharmacy, The Rotunda Hospital, Parnell Square, Dublin, Ireland
,
Cormac V. Breatnach
1  Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
› Author Affiliations
Funding This study received its funding from National Children's Research Centre (D/14/1).
Further Information

Publication History

17 December 2019

27 February 2020

Publication Date:
06 May 2020 (online)

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.

Protection of Human and Animal Subjects

No human/animal subjects were involved in this study.