Elsevier

Ambulatory Pediatrics

Volume 8, Issue 5, September–October 2008, Pages 329-335
Ambulatory Pediatrics

Insurance, Information Technology, Economics of Interventions
Impact of a Patient-Centered Technology on Medication Errors During Pediatric Emergency Care

https://doi.org/10.1016/j.ambp.2008.06.003Get rights and content

Objective

The aim of this study was to determine the impact of a patient-centered health information technology (HIT) on the error rate for ordering and prescribing of medications during emergency pediatric care.

Methods

We conducted a quasi-experimental intervention study by using control and intervention periods to evaluate the effect on medication ordering and prescribing from a patient-centered HIT designed to enhance communication between parents and emergency clinicians during emergency care. Parent-child dyads presenting to 2 emergency department (ED) sites with complaints of fever, asthma, head trauma, otalgia, and dysuria were eligible. During intervention periods, parents used the HIT to enter data on symptoms and medication-related history; a printout provided recommendations to clinicians. Data on errors/adverse drug events were collected via record reviews and phone interviews with parents. The primary outcome was the number of medication errors in orders or prescriptions for drugs targeted by the HIT.

Results

Of 2002 parent-child dyads screened, 1810 (90%) were eligible, 1411 of 1810 (78%) were enrolled, and 1410 analyzed; 1097 subjects had a total of 2234 orders or prescriptions written. Of these events, 1289 of 2234 (58%) were associated with at least 1 error. Of the 1755 errors discovered, 232 errors were serious and preventable. Among 654 patients exposed to medications targeted by the HIT, the number of errors per 100 patients during control versus intervention periods was not significantly different (173 vs 134 with both sites combined; P = .35.)

Conclusion

The patient-centered HIT demonstrated minimal impact on medication errors during ED care.

Section snippets

Overview

We completed a quasi-experimental intervention study to evaluate the effect of a patient-centered HIT on medication-related errors during pediatric ED care. During the study, control periods with usual care alternated with intervention periods wherein a parent-driven HIT application, ParentLink, elicited the child's medication and allergy history and provided tailored prescribing advice. The study was conducted between June 2005 and June 2006 at an urban tertiary care children's hospital ED

Results

Parent-child dyads were screened, and 1411 of 2002 were ultimately enrolled in the study; 1 patient was excluded from analysis due to a protocol violation, leaving 1410 subjects. Figure 2 details the screening and enrollment statistics by site. Follow-up telephone interviews were completed with 1111 of 1410 (79%) parents.

Table 1 details the characteristics of the parent-child dyads by control versus intervention period. Of 575 parents enrolled during intervention periods, 538 (94%) successfully

Discussion

We report on a novel patient-centered HIT product and its impact on the rate of medication errors in ED care for children. Experts have called for interventions targeting error-prone steps in the delivery of medications in high-risk settings.18 Overall, ParentLink demonstrated no significant impact on the rate of error.

In this study, medication errors related to communication and reconciliation appear to be low, limiting the potential benefit from ParentLink. A large number of errors were

Acknowledgment

This work was supported by grant R01 HS014947 (S.C.P.) from the Agency for Healthcare Research and Quality. Carts and batteries used during the study were donated by InfoLogix Systems.

References (20)

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Portions of this manuscript were presented in abstract form at the Pediatric Academic Societies meeting in Toronto, Canada, May 5–8, 2007.

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