World Journal of Pediatrics

, Volume 12, Issue 1, pp 28–34 | Cite as

New technologies as a strategy to decrease medication errors: how do they affect adults and children differently?

  • Margarita Ruano
  • Elena Villamañán
  • Ester Pérez
  • Alicia Herrero
  • Rodolfo Álvarez-Sala
Review article

Abstract

Background

Medication error can occur throughout the drug treatment process, with special relevance in children given the risk of adverse effects resulting from a medication error is more prevalent than in adults. The significance of medication error in children is also greater because small error that would be tolerated in adults can cause significant damage in children. Moreover, the likelihood of injury is higher than in adults.

Data sources

Based on the data published, most medication errors take place in prescribing and administration stages in both populations. Taking in account that child’s risk factors are different from those of adults, with some specific causes to pediatrics, we have reviewed available data about new technologies as a strategy to reduce pediatric medication errors.

Results

Even though there is a lack of standardized definitions and terminology that makes studies difficult to compare, we checked that new technologies have proven to be effectives in reducing medication errors, mainly computerized physician order entry (CPOE) and platforms to aid decision-making. However, we also observed that the use of these informatic tools can also generate new errors.

Conclusions

Implementation of CPOE programs for pediatrics, communication improvement between healthcare professionals taking care of admitted children and the knowledge of these programs should be the mayor priorities for the safety of hospitalized children.

Key words

electronic prescribing new technologies pediatric medication errors 

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References

  1. 1.
    Kohn LT, Corrigan JM, Donaldson ME, eds. To Err is Human: Building a Safer Health System. Washington DC: National Academy Press, 1999.Google Scholar
  2. 2.
    Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ. Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care 2007;16:116–126.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Lisby M, Nielsen LP, Brock B, Mainz J. How are medication errors defined? A systematic literature review of definitions and characteristics. Int J Qual Health Care 2010;22:507–518.PubMedCrossRefGoogle Scholar
  4. 4.
    Wong IC, Ghaleb MA, Franklin BD, Barber N. Incidence and nature of dosing errors in paediatric medications: a systematic review. Drug Saf 2004;27:661–670.PubMedCrossRefGoogle Scholar
  5. 5.
    Bulletin of the iberoamerican group systematic reviews on patient safety, 2008. http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/boletinAgencia/suplementoSeguridadPaciente/8/breves1.html (accessed March 28, 2014).Google Scholar
  6. 6.
    National Coordinating Council for Medication Error Reporting and Prevention, NCCMERP. Taxonomy of medication errors, 1998. http://www.nccmerp.org/about-medication-errors (accessed March 28, 2014).Google Scholar
  7. 7.
    Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370–376.PubMedGoogle Scholar
  8. 8.
    Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991;324:377–384.PubMedGoogle Scholar
  9. 9.
    Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications forprevention. ADE Prevention Study Group. JAMA 1995;274:29–34.Google Scholar
  10. 10.
    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;285:2114–2120.PubMedCrossRefGoogle Scholar
  11. 11.
    Chedoe I, Molendijk HA, Dittrich ST, Jansman FG, Harting JW, Brouwers JR, et al. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety: a review of the current literature. Drug Saf 2007;30:503–513.PubMedCrossRefGoogle Scholar
  12. 12.
    Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC. Systematic review of medication errors in pediatric patients. Ann Pharmacother 2006;40:1766–1776.PubMedCrossRefGoogle Scholar
  13. 13.
    Davis T. Paediatric prescribing errors. Arch Dis Child 2011;96:489–491.PubMedCrossRefGoogle Scholar
  14. 14.
    Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995;274:35–43.Google Scholar
  15. 15.
    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;111:722–729.PubMedCrossRefGoogle Scholar
  16. 16.
    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;95:113–118.PubMedCrossRefGoogle Scholar
  17. 17.
    Armada ER, Villamañán E, López-de-Sá E, Rosillo S, Rey-Blas JR, Testillano ML, et al. Computerized physician order entry in the cardiac intensive care unit: effects on prescription errors and workflow conditions. J Crit Care 2014;29:188–193.PubMedCrossRefGoogle Scholar
  18. 18.
    Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Pharmacother 2013;47:237–256.PubMedCrossRefGoogle Scholar
  19. 19.
    Tully MP, Ashcroft DM, Dornan T, Lewis PJ, Taylor D, Wass V. The causes of and factors associated with prescribing errors in hospital inpatients: a systematic review. Drug Saf 2009;32:819–836.PubMedCrossRefGoogle Scholar
  20. 20.
    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;112:431–436.PubMedCrossRefGoogle Scholar
  21. 21.
    Wong IC, Wong LY, Cranswick NE. Minimising medication errors in children. Arch Dis Child 2009;94:161–164.PubMedCrossRefGoogle Scholar
  22. 22.
    Lesar TS. Tenfold medication dose prescribing errors. Ann Pharmacother 2002;36:1833–1839.PubMedCrossRefGoogle Scholar
  23. 23.
    Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf 2013;36:1045–1067.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Steering Committee on Quality Improvement and Management and Committee on Hospital Care. Policy statement-principles of pediatric patient safety: reducing harm due to medical care. Pediatrics 2011;127:1199–1210.CrossRefGoogle Scholar
  25. 25.
    Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med 2003;348:2526–2534.PubMedCrossRefGoogle Scholar
  26. 26.
    American Academy of Pediatrics Council on Clinical Information Technology Executive Committee, 2011–2012. Electronic prescribing in pediatrics: toward safer and more effective medication management. Pediatrics 2013;131:824–826.CrossRefGoogle Scholar
  27. 27.
    Villamañán E, Herrero A, Alvarez-Sala R. Computerized physician order entry as a new technology for patients’ safety. Med Clin (Barc) 2011;136:398–402. [In Spanish]CrossRefGoogle Scholar
  28. 28.
    van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 2006;13:138–147.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Jani YH, Barber N, Wong IC. Characteristics of clinical decision support alert overrides in an electronic prescribing system at a tertiary care paediatric hospital. Int J Pharm Pract 2011;19:363–366.PubMedCrossRefGoogle Scholar
  30. 30.
    Radley DC, Wasserman MR, Olsho LE, 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;20:470–476.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, et al. Effect of computerized physician order entry and a team intervention on prevention of seriousmedication errors. JAMA 1998;280:1311–1316.PubMedCrossRefGoogle Scholar
  32. 32.
    Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999;6:313–321.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003;163:1409–1416.PubMedCrossRefGoogle Scholar
  34. 34.
    Conroy S, Sweis D, Planner C, Yeung V, Collier J, Haines L, et al. Interventions to reduce dosing errors in children: a systematic review of the literature. Drug Saf 2007;30:1111–1125.PubMedCrossRefGoogle Scholar
  35. 35.
    Cordero L, Kuehn L, Kumar RR, Mekhjian HS. Impact of computerized physician order entry on clinical practice in a newborn intensive care unit. J Perinatol 2004;24:88–93.PubMedCrossRefGoogle Scholar
  36. 36.
    Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics 2004;113:59–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Walsh KE, Adams WG, Bauchner H, Vinci RJ, Chessare JB, Cooper MR, et al. Medication errors related to computerized order entry for children. Pediatrics 2006;118:1872–1879.PubMedCrossRefGoogle Scholar
  38. 38.
    Walsh KE, Landrigan CP, Adams WG, Vinci RJ, Chessare JB, Cooper MR, et al. Effect of computer order entry on prevention of serious medication errors in hospitalized children. Pediatrics 2008;121:e421–e427.PubMedCrossRefGoogle Scholar
  39. 39.
    van Rosse F, Maat B, Rademaker CM, van Vught AJ, Egberts AC, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review. Pediatrics 2009;123:1184–1190.PubMedCrossRefGoogle Scholar
  40. 40.
    Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005;116:1506–1512.PubMedCrossRefGoogle Scholar
  41. 41.
    Del Beccaro MA, Jeffries HE, Eisenberg MA, Harry ED. Computerized provider order entry implementation: no association with increased mortality rates in an intensive care unit. Pediatrics 2006;118:290–295.PubMedCrossRefGoogle Scholar
  42. 42.
    Kim GR, Lehmann CU, Council on Clinical Information Technology. Pediatric aspects of inpatient health information technology systems. Pediatrics 2008;122:e1287–e1296.PubMedCrossRefGoogle Scholar
  43. 43.
    Maat B, Au YS, Bollen CW, van Vught AJ, Egberts TC, Rademaker CM. Clinical pharmacy interventions in paediatric electronic prescriptions. Arch Dis Child 2013;98:222–227.PubMedCrossRefGoogle Scholar
  44. 44.
    Sittig DF, Singh H. Electronic health records and national patient-safety goals. N Engl J Med 2012;367:1854–1860.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Villamañán E, Larrubia Y, Ruano M, Vélez M, Armada E, Herrero A, et al. Potential medication errors associated with computer prescriber order entry. Int J Clin Pharm 2013;35:577–583.PubMedCrossRefGoogle Scholar
  46. 46.
    Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005;293:1197–1203.PubMedCrossRefGoogle Scholar
  47. 47.
    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;169:982–989.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    American Society of Hospital Pharmacy. Pharmacy practice model initiative. http://www.ashpmedia.org/ppmi/nationaldashboard.html (accessed February 23, 2014).Google Scholar
  49. 49.
    Spanish Society of Hospital Pharmacy. 2020 initiative. http://gruposdetrabajo.sefh.es/2020/index.php (accessed February 23, 2014).Google Scholar
  50. 50.
    Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J, Calleja-Hernández MÁ, Martínez-Martínez F, Iglesias-Peinado I, et al. Implementing smart pump technology in a pediatric intensive care unit: a cost-effective approach. Int J Med Inform 2014;83:99–105.PubMedCrossRefGoogle Scholar
  51. 51.
    Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, et al. Effect of bar-code technology on the safety of medication administration. N Engl J Med 2010;362:1698–1707.PubMedCrossRefGoogle Scholar
  52. 52.
    Young J, Slebodnik M, Sands L. Bar code technology and medication administration error. J Patient Saf 2010;6:115–120.PubMedCrossRefGoogle Scholar
  53. 53.
    Miller DF, Fortier CR, Garrison KL. Bar code medication administration technology: characterization of highalert medication triggers and clinician workarounds. Ann Pharmacother 2011;45:162–168.PubMedCrossRefGoogle Scholar
  54. 54.
    Morriss FH Jr, Abramowitz PW, Nelson SP, Milavetz G, Michael SL, Gordon SN, et al. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. J Pediatr 2009;154:363–368, 368.e1.PubMedCrossRefGoogle Scholar
  55. 55.
    Husch M, Sullivan C, Rooney D, Barnard C, Fotis M, Clarke J, et al. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care 2005;14:80–86.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Trbovich PL, Pinkney S, Cafazzo JA, Easty AC. The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit. Qual Saf Health Care 2010;19:430–434.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Manrique-Rodríguez S, Sánchez-Galindo A, Fernández-Llamazares CM, López-Herce J, Echarri-Martínez L, Escudero-Vilaplana V, et al. Smart pump alerts: all that glitters is not gold. Int J Med Inform 2012;81:344–350.PubMedCrossRefGoogle Scholar
  58. 58.
    Bullock J, Jordan D, Gawlinski A, Henneman EA. Standardizing IV infusion medication concentrations to reduce variability in medication errors. Crit Care Nurs Clin North Am 2006;18:515–521.PubMedCrossRefGoogle Scholar
  59. 59.
    Villamañán E, Larrubia Y, Ruano M, Moro M, Sierra A, Pérez E, et al. Health personnel assessment about medical order entry systems of pharmacologic treatments in hospitalized patients. Rev Calid Asist 2013;28:313–320. [In Spanish]PubMedCrossRefGoogle Scholar
  60. 60.
    Spooner SA, Classen DC. Data standards and improvement of quality and safety in child health care. Pediatrics 2009;123 Suppl 2:S74–S79.PubMedCrossRefGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Margarita Ruano
    • 1
  • Elena Villamañán
    • 1
  • Ester Pérez
    • 1
  • Alicia Herrero
    • 1
  • Rodolfo Álvarez-Sala
    • 2
  1. 1.Department of PharmacyLa Paz University HospitalMadridSpain
  2. 2.Department of PneumologyLa Paz University HospitalMadridSpain
  3. 3.Department of PharmacyLa Paz University HospitalMadridSpain

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