Eur J Pediatr DOI 10.1007/s00431-015-2542-4
ORIGINAL ARTICLE
Analysis of medication prescribing errors in critically ill children Corina Glanzmann 1 & Bernhard Frey 2 & Christoph R. Meier 3 & Priska Vonbach 1
Received: 6 January 2015 / Revised: 13 March 2015 / Accepted: 13 April 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Medication prescribing errors (MPE) can result in serious consequences for patients. In order to reduce errors, we need to know more about the frequency, the type and the severity of such errors. We therefore performed a prospective observational study to determine the number and type of medication prescribing errors in critically ill children in a paediatric intensive care unit (PICU). Prescribing errors were prospectively identified by a clinical pharmacist. A total of 1129 medication orders were analysed. There were 151 prescribing errors, giving an overall error rate of 14 % (95 % CI 11 to 16). The medication groups with the highest proportion of MPEs were antihypertensives, antimycotics and drugs for nasal preparation with error rates of each 50 %, followed by antiasthmatic drugs (25 %), antibiotics (15 %) and analgesics (14 %). One hundred four errors (70 %) were classified as MPEs which required interventions and/or resulted in patient harm equivalent to 9 % of all medication orders (95 % CI 6.5 to 14.4). Forty-five MPEs (30 %) did not result in patient harm.
Communicated by Peter de Winter * Corina Glanzmann [email protected] 1
Hospital Pharmacy, University Children’s Hospital Zürich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
2
Department of Intensive Care and Neonatology, University Children’s Hospital Zürich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
3
Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, 4031 Basel, Switzerland
Conclusion: With a view to reduce MPEs and to improve patient safety, our data may help to prevent errors before they occur. What is Known: • Prescribing errors may be the most frequent medication errors. • In paediatric populations, the incidence of prescribing errors is higher than in adults. What is New: • Several risk factors for medication prescribing errors, such as medication groups, long PICU stay, and mechanical ventilation could be presented. • Analysing the combination of the most frequent prescribing errors and the severity of these errors.
Keywords Children . Intensive care . Clinical pharmacist . Prescribing error . Error rates . Classification
Abbreviations ANZPIC Australian and New Zealand Paediatric Intensive Care Registry ARF Acute renal failure ALAT Alanine-aminotransferase ASAT Aspartate-aminotransferase ATC Anatomical therapeutical chemical classification CI Confidence interval CPOE Computerized physician order entry CRP C-reactive protein die Day f Female g Gram GGT Gamma-glutamyl-transferase
Eur J Pediatr
Iv or i.v. L m MDSi mg mcg mcmol mmol MODS MPE NCCMERP PCNE PICU PIM
Intravenous (way of drug application) Litre Male Minimal data set intensive care Milligram Microgram Micromol Millimol Multiple organ dysfunction syndrome Medication prescribing error National Coordinating Council for Medication Error Reporting and Prevention Pharmaceutical Care Network Europe Paediatric intensive care unit Paediatric Index of Mortality Score
Introduction In the current health care system, especially in neonatal and paediatric intensive care, medication errors are possibly an important source of morbidity [13, 18, 21, 32, 33, 40, 41] and efforts for improvement are paramount. Medication errors range from those with very serious consequences to those that have little impact on the patient. It has thus been suggested that the severity as well as the prevalence of errors should be taken into account [2]. Assessing the severity of errors increases the quality of information regarding the clinical relevance. Children are a challenging group of patients because most drug dosages in paediatric medication are calculated individually, based on the patient’s age, weight or body surface area. Furthermore, the frequency of unlicensed and off label drug prescriptions is about 50 to 70 % depending on the method of analysis and the clinical setting [8]. This may increase the potential for medication errors. Limited evidence suggests that the prevalence of medication errors and corresponding harm may be higher in children than in adults (1.1 vs 0.35 %, P
ORIGINAL ARTICLE
Analysis of medication prescribing errors in critically ill children Corina Glanzmann 1 & Bernhard Frey 2 & Christoph R. Meier 3 & Priska Vonbach 1
Received: 6 January 2015 / Revised: 13 March 2015 / Accepted: 13 April 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Medication prescribing errors (MPE) can result in serious consequences for patients. In order to reduce errors, we need to know more about the frequency, the type and the severity of such errors. We therefore performed a prospective observational study to determine the number and type of medication prescribing errors in critically ill children in a paediatric intensive care unit (PICU). Prescribing errors were prospectively identified by a clinical pharmacist. A total of 1129 medication orders were analysed. There were 151 prescribing errors, giving an overall error rate of 14 % (95 % CI 11 to 16). The medication groups with the highest proportion of MPEs were antihypertensives, antimycotics and drugs for nasal preparation with error rates of each 50 %, followed by antiasthmatic drugs (25 %), antibiotics (15 %) and analgesics (14 %). One hundred four errors (70 %) were classified as MPEs which required interventions and/or resulted in patient harm equivalent to 9 % of all medication orders (95 % CI 6.5 to 14.4). Forty-five MPEs (30 %) did not result in patient harm.
Communicated by Peter de Winter * Corina Glanzmann [email protected] 1
Hospital Pharmacy, University Children’s Hospital Zürich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
2
Department of Intensive Care and Neonatology, University Children’s Hospital Zürich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
3
Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, 4031 Basel, Switzerland
Conclusion: With a view to reduce MPEs and to improve patient safety, our data may help to prevent errors before they occur. What is Known: • Prescribing errors may be the most frequent medication errors. • In paediatric populations, the incidence of prescribing errors is higher than in adults. What is New: • Several risk factors for medication prescribing errors, such as medication groups, long PICU stay, and mechanical ventilation could be presented. • Analysing the combination of the most frequent prescribing errors and the severity of these errors.
Keywords Children . Intensive care . Clinical pharmacist . Prescribing error . Error rates . Classification
Abbreviations ANZPIC Australian and New Zealand Paediatric Intensive Care Registry ARF Acute renal failure ALAT Alanine-aminotransferase ASAT Aspartate-aminotransferase ATC Anatomical therapeutical chemical classification CI Confidence interval CPOE Computerized physician order entry CRP C-reactive protein die Day f Female g Gram GGT Gamma-glutamyl-transferase
Eur J Pediatr
Iv or i.v. L m MDSi mg mcg mcmol mmol MODS MPE NCCMERP PCNE PICU PIM
Intravenous (way of drug application) Litre Male Minimal data set intensive care Milligram Microgram Micromol Millimol Multiple organ dysfunction syndrome Medication prescribing error National Coordinating Council for Medication Error Reporting and Prevention Pharmaceutical Care Network Europe Paediatric intensive care unit Paediatric Index of Mortality Score
Introduction In the current health care system, especially in neonatal and paediatric intensive care, medication errors are possibly an important source of morbidity [13, 18, 21, 32, 33, 40, 41] and efforts for improvement are paramount. Medication errors range from those with very serious consequences to those that have little impact on the patient. It has thus been suggested that the severity as well as the prevalence of errors should be taken into account [2]. Assessing the severity of errors increases the quality of information regarding the clinical relevance. Children are a challenging group of patients because most drug dosages in paediatric medication are calculated individually, based on the patient’s age, weight or body surface area. Furthermore, the frequency of unlicensed and off label drug prescriptions is about 50 to 70 % depending on the method of analysis and the clinical setting [8]. This may increase the potential for medication errors. Limited evidence suggests that the prevalence of medication errors and corresponding harm may be higher in children than in adults (1.1 vs 0.35 %, P
