Elizabeth Manias1, Sharon Kinney2, Noel Cranswick2, Allison Williams3, Narelle Borrott4. 1. Deakin University, Burwood, VIC, Australia The University of Melbourne, Parkville, VIC, Australia emanias@deakin.edu.au. 2. The University of Melbourne, Parkville, VIC, Australia Royal Children's Hospital, Parkville, VIC, Australia. 3. Monash University, Clayton, VIC, Australia. 4. Griffith University, Brisbane, QLD, Australia.
Abstract
OBJECTIVE: To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units. DATA SOURCES: Databases were searched from inception to April 2014. STUDY SELECTION AND DATA EXTRACTION: Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors. DATA SYNTHESIS: In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ(2)(5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79); IS: 0.37 (95% CI = 0.19, 0.73); ME: 0.36 (95% CI = 0.22, 0.58); PG: 0.82 (95% CI = 0.21, 3.25); PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03). CONCLUSIONS: Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions.
OBJECTIVE: To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units. DATA SOURCES: Databases were searched from inception to April 2014. STUDY SELECTION AND DATA EXTRACTION: Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors. DATA SYNTHESIS: In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ(2)(5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79); IS: 0.37 (95% CI = 0.19, 0.73); ME: 0.36 (95% CI = 0.22, 0.58); PG: 0.82 (95% CI = 0.21, 3.25); PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03). CONCLUSIONS: Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions.
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