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.
Keywords
clinical information systems - intensive and critical care - pediatrics - computer-assisted
decision-making - medical order entry systems - prescriptions - medication errors
- infusion pumps
