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International Journal of Clinical Pharmacy

, Volume 36, Issue 6, pp 1179–1189 | Cite as

Use of the Delphi technique to determine safety features to be included in a neonatal and paediatric prescription chart

  • A. Cassar FloresEmail author
  • S. Marshall
  • M. Cordina
Research Article

Abstract

Background Neonatal and paediatric patients are especially vulnerable to serious injury as a result of medication errors due to their small size, physiological immaturity and limited compensatory abilities. The prescription chart remains an essential form of communication of prescribing decisions and instructions. Modifications to the safety features of prescription charts have been shown to reduce the frequency of medication errors. Objective To determine, using the Delphi technique, which safety features should be included in the inpatient neonatal and paediatric prescription chart to help minimise the risk of medication errors associated with the use of the chart. Setting Acute general hospital in Malta. Method A two-round modified e-Delphi process was conducted. The Delphi questionnaire was developed from a mapping process, a literature search and references supporting the literature review. It comprised 155 safety features for consensus. The Delphi panel consisted of nine doctors, five nurses and four pharmacists. Participants were asked to rate their agreement to the inclusion of these features in the local chart using a three-point Likert scale, and to add further comments as necessary at the end of each section. In the second round, participants were given the opportunity to change their individual response in view of the groups’ response. Main outcome measure This was set at a 70 % level of agreement. Results Results from each round were analysed to provide the percentage frequencies and number of participants who chose each point from the Likert scale provided, and the response count for each safety feature. A ≥70 % consensus level was achieved on: 115 safety features in Round 1 (total: 155 safety features) and 23 safety features in Round 2 (total: 40 safety features) while only 17 safety features did not achieve consensus at the end of the process. Conclusion Consensus was achieved on 133 safety features to be included in the neonatal and paediatric prescription chart. Five safety features achieved consensus disagreement for their inclusion in the chart. Identifying the appropriate safety features forms part of an essential strategy to reduce the incidence of medication errors associated with the use of the chart in these patients.

Keywords

Delphi technique Guideline Malta Medication safety Pediatrics Prescribing 

Notes

Funding

No external funding has been obtained for this study.

Conflicts of interest

There are no conflicts of interest within the submitted manuscript.

Supplementary material

11096_2014_14_MOESM1_ESM.docx (33 kb)
Supplementary material (DOCX 34 kb)

References

  1. 1.
    Otero P, Leyton A, Mariani G, Ceriani Cernadas JM. Patient Safety Committee. Medication errors in pediatric inpatients: prevalence and results of a prevention program. Pediatrics. 2008;122(3):e 737–43.CrossRefGoogle Scholar
  2. 2.
    Ghaleb MA, Barber N, Franklin BD. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010;95(2):113–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Conroy S, Appleby K, Bostock D, Unsworth V, Cousins D. Medication errors in a children’s hospital. Paediatr Perinat Drug Ther. 2007;8(1):18–25.CrossRefGoogle Scholar
  4. 4.
    Miller MR, Takata G, Stucky ER, Neuspiel DR. Policy statement- principles of pediatric patient safety: reducing harm due to medical care. Pediatrics. 2011;127(6):1199–210.CrossRefGoogle Scholar
  5. 5.
    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(2):431–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Simpson J, Lynch R, Grant J, Alroomi L. Reducing medication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F 480–2.CrossRefGoogle Scholar
  7. 7.
    Suresh G, Horbar JD, Plsek P, Gray J, Edwards WH, Shiono PH, et al. Voluntary anonymous reporting of medical errors for neonatal intensive care. Pediatrics. 2004;113(6):1609–18.PubMedCrossRefGoogle Scholar
  8. 8.
    Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics. 1987;79(5):718–22.PubMedGoogle Scholar
  9. 9.
    Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA J Am Med Assoc. 2001;285(16):2114–20.CrossRefGoogle Scholar
  10. 10.
    Raju TNK, Thornton JP, Kecskes S, Perry M, Feldman S. Medication errors in neonatal and paediatric intensive-care units. Lancet. 1989;334(8659):374–6.CrossRefGoogle Scholar
  11. 11.
    Snijders C, van Lingen RA, Molendijk A, Fetter WPF. Incidents and errors in neonatal intensive care: a review of the literature. Arch Dis Child Fetal Neonatal Ed. 2007;92(5):F 391–8.CrossRefGoogle Scholar
  12. 12.
    Ghaleb MA, Wong ICK. Medication errors in paediatric patients. Arch Dis Child Educ Pract Ed. 2006;91:20–4.CrossRefGoogle Scholar
  13. 13.
    Walsh K, Kaushal R, Chessare J. How to avoid paediatric medication errors: a user’s guide to the literature. Arch Dis Child. 2005;90(7):698–702.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Levine SR, Cohen MR, Blanchard NR, Frederico F, Magelli M, Lomax C, et al. Guidelines for preventing medication errors in pediatrics. J Pediatr Pharmacol Ther. 2001;6:427–43.Google Scholar
  15. 15.
    Velo GP, Minuz P. Medication errors: prescribing faults and prescription errors. Br J Clin Pharmacol. 2009;67(6):624–8.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Coombes ID, Reid C, Mc Dougall D, Stowasser D, Duiguid M, Mitchell C. Pilot of a National Inpatient Medication Chart in Australia: improving prescribing safety and enabling prescribing training. Br J Clin Pharmacol. 2011;72(2):338–49.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Coombes ID, Stowasser DA, Reid C, Mitchell CA. Impact of a standard medication chart on prescribing errors: a before-and-after audit. Qual Saf Health Care. 2009;18(6):478–85.PubMedCrossRefGoogle Scholar
  18. 18.
    National Patient Safety Agency. Promoting safer use of injectable medicines [Internet]. London: National Patient Safety Agency; 2007 [cited 2011 Oct 15]. Available from. http://www.nrls.npsa.nhs.uk/resources/?entryid45=59812.
  19. 19.
    Government of Western Australia Department of Health. WA paediatric inpatient medication chart & paediatric long-stay medication chart: introduction and rationale [internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 2011 Oct 15]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/Paediatric_Medication_Charts_Guide_using_chart.pdf.
  20. 20.
    Academy of Medical Royal Colleges, Royal Pharmaceutical Society, Royal College of Nursing. Standards for the design of hospital in-patient prescription charts (Internet). London: Academy of Medical Royal Colleges; 2011 (cited 17 Nov 2011). Available from. http://www.aomrc.org.uk/projects/standards-for-the-design-of-hospital-in-patient-prescription-charts.html.
  21. 21.
    Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, Tully M, Wass V. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. Equip study [Internet]. [place unknown: publisher unknown]; 2009 [cited 18 May 2013]. Available from. http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf.
  22. 22.
    Millar JA, Silla RC, Lee GE, Berwick A. The national inpatient medication chart: critical audit of design and performance at a tertiary hospital. Med J Aust. 2008;188(2):95–9.PubMedGoogle Scholar
  23. 23.
    Agrawal A. Medication errors: prevention using information technology systems. Br J Clin Pharmacol. 2009;67(6):681–6.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Reeve J, Sweidan M. Setting a standard for electronic prescribing systems. Aust Prescr. 2011;34(1):2–4.Google Scholar
  25. 25.
    Radley DC, Wasserman MR, Olsho LEW, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc. 2013;20(3):470–6.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Academy of Medical Royal Colleges. Helping to reduce prescribing errors by developing standards for the design of hospital in-patient prescription charts [Internet]. London: Academy of Medical Royal Colleges; 2011 [cited 17 Nov 2011]. Available from. http://www.aomrc.org.uk/projects/standards-for-the-design-of-hospital-in-patient-prescription-charts.html.
  27. 27.
    Stephenson H. Electronic prescribing in hospitals: the road ahead. Aust Prescr. 2001;24:2–3.Google Scholar
  28. 28.
    Mäkinen M, Rautava P, Forsström J, Aärimaa M. Electronic prescriptions are slowly spreading in the European Union. Telemed J E Health. 2011;17(3):217–22.PubMedCrossRefGoogle Scholar
  29. 29.
    Routledge PA. A national in-patient prescription chart: the experience in Wales 2004–2012. Br J Clin Pharmacol. 2012;74(4):561–5.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    U.S. National Library of Medicine. Fact Sheet Medline® [Internet]. Bethesda: US. National Library of Medicine; 2004–2011 (cited 12 Sep 2011). Available from. http://www.nlm.nih.gov/pubs/factsheets/medline.html.
  31. 31.
    EBSCO. Nursing Resources from EBSCO Health [Internet]. Ipswich: EBSCO Industries, Inc.; 2011 [cited 12 Sep 2011]. Available from. http://www.ebscohost.com/nursing/products/cinahl-databases/cinahl-complete.
  32. 32.
    Government of Western Australia Department of Health. Paediatric National Inpatient Medication Chart, Short-Stay [Internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 15 Oct 2011]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/11388_Paed_Short_Stay_Med_Chart.pdf.
  33. 33.
    Government of Western Australia Department of Health. Paediatric National Inpatient Medication Chart, Long-Stay [Internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 15 Oct 2011]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/HP8870_NIMC_long_stay.pdf.
  34. 34.
    Government of Western Australia Department of Health. Neonatal Medication Chart [Internet]. Western Australia: Government of Western Australia Department of Health; 2010 [cited 15 Oct 2011]. Available from. http://www.safetyandquality.health.wa.gov.au/docs/medication_safety/neonatal_medication_chart.pdf.
  35. 35.
    Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311(7001):376–80.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 15–16 p. ISBN: 9781405187541.Google Scholar
  37. 37.
    Fitch K, Bernstein SJ, Aguilar MD, Burnand B, La Calle JR, Lazaro P, et al. The RAND/UCLA Appropriateness Method. Santa Monica, Arlington: RAND; 2001. 6–7 p. ISBN:0833029185.Google Scholar
  38. 38.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 3–4 p. ISBN: 9781405187541.Google Scholar
  39. 39.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 3 p. ISBN: 9781405187541.Google Scholar
  40. 40.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 7–8 p. ISBN: 9781405187541.Google Scholar
  41. 41.
    SurveyMonkey. Create Surveys. Get Answers [Internet]. [place unknown]: SurveyMonkey; 1999–2011 [cited 2011 Dec 29]. Available from. http://www.surveymonkey.com.
  42. 42.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 9 p. ISBN: 9781405187541.Google Scholar
  43. 43.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 8 p. ISBN: 9781405187541.Google Scholar
  44. 44.
    Marshall MN. Sampling for qualitative research. Fam Pract. 1996;13(6):522–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 46 p. ISBN: 9781405187541.Google Scholar
  46. 46.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 54 p. ISBN: 9781405187541.Google Scholar
  47. 47.
    Paediatric Formulary Committee. British National Formulary for Children. London: BMJ Group, Pharmaceutical Press and RCPCH Publications; 2011–2012. 4–5 p. ISBN: 9780853699590.Google Scholar
  48. 48.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 76 p. ISBN: 9781405187541.Google Scholar
  49. 49.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 78–81 p. ISBN: 9781405187541.Google Scholar
  50. 50.
    Holey EA, Feeley JL, Dixon J, Whittaker VJ. An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol. 2007;29(7):52.CrossRefGoogle Scholar
  51. 51.
    Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. J Inf Manag. 2004;42(1):15–29.CrossRefGoogle Scholar
  52. 52.
    Smith F. Conducting your pharmacy practice research project. London: Pharmaceutical Press: 2010. 183 p. ISBN: 978 0 85369 869 2.Google Scholar
  53. 53.
    Smith F. Conducting your pharmacy practice research project. London: Pharmaceutical Press: 2010. 126–127 p. ISBN: 978 0 85369 869 2.Google Scholar
  54. 54.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 57 p. ISBN: 9781405187541.Google Scholar
  55. 55.
    Wakefield DS, Wakefield BJ. Are verbal orders a threat to patient safety? Qual Saf Health Care. 2009;27(18):165–8.Google Scholar
  56. 56.
    Hughes RG, Edgerton EA. Reducing pediatric medication errors: children are especially at risk for medication errors. Am J Nurs. 2005;105(5):79–84.PubMedCrossRefGoogle Scholar
  57. 57.
    Shane R. Current status of administration of medicines. Am J Health-Syst Pharm. 2009;66(5):s42–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Chua SS, Chua HM, Omar A. Drug administration errors in paediatric wards: a direct observation approach. Eur J Pediatr. 2010;169(5):603–11.PubMedCrossRefGoogle Scholar
  59. 59.
    Institute for Safe Medication Practices. Independent Double Checks: Undervalued And Misused: Selective Use Of This Strategy Can Play An Important Role In Medication Safety [Internet]. Horsham: Institute for Safe Medication Practices; 2013 [cited 2014 Jul 08]. Available from. http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=51.
  60. 60.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 11 p. ISBN: 9781405187541.Google Scholar
  61. 61.
    Powell C. The Delphi technique: myths and realities. J Adv Nurs. 2003;41(4):376–82.PubMedCrossRefGoogle Scholar
  62. 62.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 29 p. ISBN: 9781405187541.Google Scholar
  63. 63.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 70 p. ISBN: 9781405187541.Google Scholar
  64. 64.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 77 p. ISBN: 9781405187541.Google Scholar
  65. 65.
    Moore CM. Group Techniques for Idea Building. California: Sage Publications; 1987. 56 p. ISBN: 978-0803923850.Google Scholar
  66. 66.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 63 p. ISBN: 9781405187541.Google Scholar
  67. 67.
    Keeney S, Hasson F, Mc Kenna H. The Delphi Technique in Nursing and Health Research. West Sussex: Wiley Blackwell; 2011. 28 p. ISBN: 9781405187541.Google Scholar
  68. 68.
    Sweidan M, Williamson M, Reeve JF, Harvey K, O’Neill JA, Schattner P, Snowdon T. Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process. BMC Medical Informatics and Decision Making. 2010 Apr 15; 10 (21).Google Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  1. 1.Medicines Information and Clinical Pharmacy SectionMater Dei HospitalMsidaMalta
  2. 2.School of Pharmacy and Life SciencesRobert Gordon UniversityAberdeenScotland, UK
  3. 3.Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta

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