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Minimising Prescribing Errors in Paediatrics ‐ Clinical Audit 

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Author(s): Raquel Romero‐Perez | Dr Philippa Hildick‐Smith 

Journal: Scottish Universities Medical Journal
ISSN 2049-8454

Volume: Epub;
Issue: 1;
Start page: 1;
Date: 2012;
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Keywords: patient safety |  safe prescribing |  pharmacy |  paediatrics 

ABSTRACT
Background: Thousands of medicines are prescribed in the UK every day without any problem, but medication errors occur with potential for serious impact on patient safety.Objectives: This study had three core objectives: 1) To measure the incidence and nature of prescribing errors in a children’s teaching hospital. 2) To explore the factors contributing to them. 3) Use clinician feedback to design an intervention to help reduce errors according to local needs and resources.Methods: A prospective review of in-patient medication charts, out-patient prescriptions and electronic discharge summaries was carried out for two consecutive weeks to identify the incidence and types of prescribing errors. An online survey and questionnaire was sent amongst doctors, pharmacists and nurses to explore the perceived causes of prescribing errors. Suggested strategies from healthcare professionals in the online survey and questionnaire were used to devise a paediatric prescribing pocket guide that was given out to all prescribers.Results: Prescribing mean error rates varied between written in-patient drug charts (56.8%), out-patient prescriptions (46.8%), and electronic discharge medication orders (19.0%). The three most common types of errors were unit dose missing (29.4%), valid period missing (23.4%) and administration times missing or incorrect (9.4%). Potentially serious errors were less common (6.4%) and almost all were intercepted before they could affect patients. The three most frequently suggested causes of errors were being busy/rushing (73.9%), being tired/not concentrating (47.8%) and not checking (45.7%). Errors were mostly thought to arise when starting a new post (56.5%), when on-call (47.8%), and at the end of a working day (39.1%). After review, a majority of positive views were collected regarding the design, content and usefulness of the paediatric prescribing pocket guide. This intervention would be subject to review and audit in due course.Conclusions: This study reinforces the message that prescribing errors are common in secondary care paediatrics and more needs to be done to reduce such errors impacting patient care. Prescribing errors are often multifactorial and efforts to reduce them need to address multiple causes to be of some benefit. Future research will investigate the impact of the devised educational intervention in reducing local prescribing errors and improving clinical practice.
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