Abstract
Background There is a lack of large comprehensive studies in developing countries on paediatric in-patient prescribing errors in different settings. Objectives To determine the characteristics of in-patient prescribing errors among paediatric patients. Setting General paediatric wards, neonatal intensive care units and paediatric intensive care units in government hospitals in Malaysia. Methods This is a cross-sectional multicentre study involving 17 participating hospitals. Drug charts were reviewed in each ward to identify the prescribing errors. All prescribing errors identified were further assessed for their potential clinical consequences, likely causes and contributing factors. Main outcome measures Incidence, types, potential clinical consequences, causes and contributing factors of the prescribing errors. Results The overall prescribing error rate was 9.2% out of 17,889 prescribed medications. There was no significant difference in the prescribing error rates between different types of hospitals or wards. The use of electronic prescribing had a higher prescribing error rate than manual prescribing (16.9 vs 8.2%, p < 0.05). Twenty eight (1.7%) prescribing errors were deemed to have serious potential clinical consequences and 2 (0.1%) were judged to be potentially fatal. Most of the errors were attributed to human factors, i.e. performance or knowledge deficit. The most common contributing factors were due to lack of supervision or of knowledge. Conclusions Although electronic prescribing may potentially improve safety, it may conversely cause prescribing errors due to suboptimal interfaces and cumbersome work processes. Junior doctors need specific training in paediatric prescribing and close supervision to reduce prescribing errors in paediatric in-patients.
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References
Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285:2114–20.
NHS National Patient Safety Agency. Review of patient safety for children and young people. National Reporting and Learning Service, 2009. ISBN: 978-1-906624-07-1.
Choonara I, Conroy S. Unlicensed and off-label drug use in children: implications for safety. Drug Saf. 2002;25:1–5.
Conroy S, McIntyre J. The use of unlicensed and off-label medicines in the neonate. Semin Fetal Neonat Med. 2005;10:115–22.
Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC. Systematic review of medication errors in pediatric patients. Ann Pharmacother. 2006;40:1766–76.
Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010;95:113–8.
Ghaleb MA, Barber N, Franklin BD, Wong IC. What constitutes a prescribing error in paediatrics? Qual Saf Health Care. 2005;14:352–7.
Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential clinical consequences. Int J Qual Health Care. 2005;17:15–22.
NCC MERP Taxonomy of Medication Errors. http://www.nccmerp.org/sites/default/files/taxonomy2001-07-31.pdf. Accessed 01 Feb 2017.
Taib IA, McIntosh AS. On the integration and standardization of medication error data: taxonomies, terminologies, causes and contributing factors. Ther Adv Drug Saf. 2010;1:53–63.
Walsh KE, Kaushal R, Chessare JB. How to avoid paediatric medication errors: a user’s guide to the literature. Arch Dis Child. 2005;90:698–702.
Singh H, Mani S, Espadas D, Petersen N, Franklin V, Petersen LA. Prescription errors and outcomes related to inconsistent information transmitted through computerized order entry: a prospective study. Arch Intern Med. 2009;169:982–9.
Walsh KE, Miller MR, Vinci RJ, Bauchner H. Pediatric resident education about medical errors. Ambul Pediatr. 2004;4:514–7.
Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282:267–70.
Vessal G. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward. Pharm World Sci. 2010;32:59–65.
Costello JL, Torowicz DL, Yeh TS. Effects of a pharmacist-led pediatrics medication safety team on medication-error reporting. Am J Health Syst Pharm. 2007;64:1422–6.
Fortescue EB, Kaushal R, Landrigan CP, McKenna KJ, Clapp MD, Federico F, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;111(4 Pt 1):722–9.
Silva Md, Rosa MB, Franklin BD, Reis AM, Anchieta LM, Mota JA. Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study. Clinics (Sao Paulo). 2011;66:1691–7.
Al-Jeraisy MI, Alanazi MQ, Abolfotouh MA. Medication prescribing errors in a pediatric inpatient tertiary care setting in Saudi Arabia. BMC Res Notes. 2011;4:294.
Ross LM, Wallace J, Paton JY. Medication errors in a paediatric teaching hospital in the UK: five years operational experience. Arch Dis Child. 2000;83:492–7.
Institute for Safe Medication Practices. 2016–2017 Targeted Medication Safety Best Practices for Hospitals. http://www.ismp.org/tools/bestpractices/TMSBP-for-hospitals.pdf. Accessed 01 Feb 2017.
The Joint Commission (2008) Preventing pediatric medication errors. https://www.jointcommission.org/assets/1/18/SEA_39.pdf. Accessed 01 Feb 2017.
Stucky ER. American academy of pediatrics committee on drugs; american academy of pediatrics committee on hospital care. prevention of medication errors in the pediatric inpatient setting. Pediatrics. 2003;112:431–6.
The Health Foundation. Evidence scan. Reducing Prescribing Error. http://www.health.org.uk/sites/health/files/ReducingPrescribingErrors.pdf. Accessed 01 Feb 2017.
Acknowledgement
This observational collaborative study was proposed at the National Paediatricians’ Conference of Ministry of Health, Malaysia at Port Dickson in September 2014. We would like to acknowledge all the paediatricians and pharmacists who acted as auditors in the study and thank the Director General of Health of Malaysia for the permission to publish the results of this study.
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This study did not receive any funding.
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Khoo, T.B., Tan, J.W., Ng, H.P. et al. Paediatric in-patient prescribing errors in Malaysia: a cross-sectional multicentre study. Int J Clin Pharm 39, 551–559 (2017). https://doi.org/10.1007/s11096-017-0463-1
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DOI: https://doi.org/10.1007/s11096-017-0463-1