Approaches recommended to reduce medication errors in paediatric
| Approaches to reduce medication errors | Entities supporting approach (reference citations at end of table) | Based on published effectiveness evidence specific for children? | Alternative processes used to support approach | Efficacy, cost, feasibility, appropriateness in different settings, barriers data available for children? |
|---|---|---|---|---|
| PPAG, Pediatric Pharmacy Advocacy Group4–6; ISMP, Institute for Safe Medication Practices4–6; AHA, American Hospital Association7,8; AAP/NICHQ, American Academy of Pediatrics/National Initiative for Children’s Healthcare Quality9–12; IOM, Institute of Medicine1; NQF, National Quality Forum13,14; MHA, Massachusetts Hospital Association/Massachusetts Coalition for the Prevention of Medical Errors15,16; NCC MERP, National Coordinating Council for Medication errors Reporting and Prevention17,18; AHRQ, Agency for Healthcare Research and Quality19,20; JCAHO, Joint Commission on Accreditation of Healthcare Organizations.21,22 | ||||
| 1. Computerised provider order entry | PPAG, ISMP, AHA | No | Expert opinion | No |
| AHRQ report | No | Adult data | No | |
| AAP/NICHQ | No | Expert opinion | No | |
| IOM report | No | Adult data | No | |
| NQF | No | Adult data | No | |
| MHA | No | Adult data | No | |
| NCC MERP | No | Expert opinion | No | |
| AAP | No | Expert opinion | No | |
| 2. Automated dispensing devices | ISMP, PPAG, AHA | No | Expert opinion | No |
| AHRQ report | No | Adult data | No | |
| 3. Paediatric presence with formulary management | ISMP, PPAG, AHA | No | Expert opinion | No |
| AAP | No | Expert opinion | No | |
| 4. Appropriate and competent pharmacy personnel and environment | ISMP, PPAG, AHA | No | Expert opinion | No |
| NQF | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| AAP | No | Expert opinion | No | |
| 5. Pharmacist available “on call” when pharmacy is closed | ISMP, PPAG | No | Expert opinion | No |
| AHA | No | Expert opinion | No | |
| MHA | No | Expert opinion | No | |
| 6. Policies on verbal orders | ISMP, PPAG, AHA | No | Expert opinion | No |
| JCAHO | No | Expert opinion | No | |
| NQF | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| AAP | No | Expert opinion | No | |
| 7. Clear and accurate labelling of medications | ISMP, PPAG, AHA | No | Expert opinion | No |
| NQF | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| 8. Quality improvement efforts with drug use evaluation and medication error reporting and review | ISMP, PPAG, AHA | No | Expert opinion | No |
| MHA | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| AAP | No | Expert opinion | No | |
| 9. Healthcare workers have access to current clinical information and references | ISMP, PPAG, AHA | No | Expert opinion | No |
| IOM report | No | Expert opinion | No | |
| MHA | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| AAP | No | Expert opinion | No | |
| 10. Emergency medication dosage calculation tools | ISMP, PPAG | No | Expert opinion | No |
| 11. Accurate documentation of medication administration | ISMP, PPAG | No | Expert opinion | No |
| MHA | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| 12. Medication standardisation and appropriate storage | ISMP, AHA | No | Expert opinion | No |
| IOM report | No | Expert opinion | No | |
| JCAHO | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| 13. Training of all healthcare providers in appropriate medication prescribing, labelling, dispensing, monitoring, and administration | ISMP, PPAG | No | Expert opinion | No |
| IOM report | No | Expert opinion | No | |
| JCAHO | No | Expert opinion | No | |
| NQF | No | Expert opinion | No | |
| MHA | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| AAP | No | Expert opinion | No | |
| 14. Patient education on drugs | ISMP, AHA | No | Expert opinion | No |
| IOM report | No | Expert opinion | No | |
| MHA | No | Expert opinion | No | |
| NCC MERP | No | Expert opinion | No | |
| AAP | No | Expert opinion | No | |
| 15. Direct participation of pharmacists in clinical care | AHRQ report | No | Some studies | No |
| IOM report | No | Expert opinion | No | |
| NQF | No | Expert opinion | No | |
| 16. Computer detection/alert systems for adverse drug events | AHRQ report | No | Some studies | No |
| 17. Reducing adverse drug events related to anticoagulants | AHRQ report | No | Some studies | No |
| 18. Unit dose drug distribution systems | AHRQ report | No | Some studies | No |
| AHA | No | Expert opinion | No | |
| NQF | No | Expert opinion | No | |
| MHA | No | Expert opinion | No | |
| 19. Special procedures and written protocols for high alert drugs | AHA | No | Expert opinion | No |
| IOM report | No | Expert opinion | No | |
| NQF | No | Expert opinion | No | |
| JCAHO | No | Expert opinion | No | |
| MHA | No | Expert opinion | No | |
| 20. Use pharmaceutical software | IOM report | No | Expert opinion | No |
| MHA | No | Expert opinion | No | |
| 21. Pharmacy-based IV admixture systems | MHA | No | Expert opinion | No |
| 22. Use of bar coding for medication administration | MHA | No | Expert opinion | No |
| NCC MERP | No | Expert opinion | No | |
| 23. Standardise equipment (e.g., pumps, weight scales) | AAP | No | Expert opinion | No |
| 24. Standardise measurement systems (kilograms) | AAP | No | Expert opinion | No |
| 25. Standardise order sheets to include areas for weight and allergies | AAP | No | Expert opinion | No |
| 26. Encourage team environment for review of orders among nurses, pharmacists, prescribers | AAP | No | Expert opinion | No |