Paediatric dosing errors before and after electronic prescribing
- 1Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London & the Institute of Child Health, University College London, London, UK
- 2Department of Practice and Policy, the School of Pharmacy, University of London, London, UK
- 3Pharmacy Department, University College London Hospitals NHS Foundation Trust, London, UK
- Correspondence to Dr Yogini Jani, Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London, 29-39 Brunswick Square, London WC1N 1AX, UK;
Contributors YHJ: design, data collection, analysis and interpretation, and writing manuscript; NB: conception and design, interpretation of data and contribution to manuscript; ICKW: conception and design, interpretation of data, contribution to manuscript and guarantor.
- Accepted 7 January 2010
Objective To compare the incidence and severity rating of dose prescribing errors before and after the implementation of a commercially available electronic prescribing system at a tertiary care children's hospital.
Methods Dose errors were identified using prescription review to detect errors. Severity rating was determined by five judges using a validated, reliable scoring tool. The mean score for each error was used as an index of severity.
Results Dose prescribing errors occurred in 88 of the 3939 (2.2%) items prescribed for outpatients and inpatients, and on discharge prescriptions prior to the implementation of electronic prescribing (EP). After EP, there were 57 dose errors in 4784 (1.2%) items prescribed (1% absolute reduction (p<0.001 χ2 test; 95% CI of difference in proportions −1.6% to −0.5%)). A decrease in the severity rating of dose errors was also seen: dose errors with potentially minor outcomes 35/3939 (0.89%) pre vs 21/4784 (0.44%) post (95% CI of difference in proportions −0.8% to −0.11%, p=0.009 χ2 test); moderate outcome 46/3939 (1.17%) pre vs 33/4784 (0.69%) post (95% CI of difference in proportions −0.91% to −0.08, p=0.019, χ2 test); severe outcome: 7/3939 (0.18%) pre vs 3/4784 (0.06%) post (95% CI of difference in proportions −0.31% to +0.04, p=0.11, χ2 test).
Conclusion Electronic prescribing appears to reduce rates of dosing errors in paediatrics, but larger studies are required to assess the effect on the severity of these errors and in different settings.
- Electronic prescribing
- medical order entry systems
- medication errors
- dose errors
- information technology
Funding Great Ormond Street Hospital for Children, First Databank Europe Ltd and JAC Computer Systems Ltd.
Competing interests None.
Ethics approval Ethics approval was provided by the Institute of Child Health/Great Ormond Street Hospital Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.