David Palmero1,2,3, Ermindo R Di Paolo4, Lydie Beauport5, André Pannatier6, Jean-François Tolsa7. 1. Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. david.palmero@chuv.ch. 2. Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. david.palmero@chuv.ch. 3. School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland. david.palmero@chuv.ch. 4. Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. Ermindo.Di-Paolo@chuv.ch. 5. Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. lydie@beauport.eu. 6. Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. Andre.Pannatier@chuv.ch. 7. Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. Jean-Francois.Tolsa@chuv.ch.
Abstract
The objective of this study was to assess whether the introduction of a new preformatted medical order sheet coupled with an introductory course affected prescription quality and the frequency of errors during the prescription stage in a neonatal intensive care unit (NICU). Two-phase observational study consisting of two consecutive 4-month phases: pre-intervention (phase 0) and post-intervention (phase I) conducted in an 11-bed NICU in a Swiss university hospital. Interventions consisted of the introduction of a new preformatted medical order sheet with explicit information supplied, coupled with a staff introductory course on appropriate prescription and medication errors. The main outcomes measured were formal aspects of prescription and frequency and nature of prescription errors. Eighty-three and 81 patients were included in phase 0 and phase I, respectively. A total of 505 handwritten prescriptions in phase 0 and 525 in phase I were analysed. The rate of prescription errors decreased significantly from 28.9% in phase 0 to 13.5% in phase I (p < 0.05). Compared with phase 0, dose errors, name confusion and errors in frequency and rate of drug administration decreased in phase I, from 5.4 to 2.7% (p < 0.05), 5.9 to 0.2% (p < 0.05), 3.6 to 0.2% (p < 0.05), and 4.7 to 2.1% (p < 0.05), respectively. The rate of incomplete and ambiguous prescriptions decreased from 44.2 to 25.7 and 8.5 to 3.2% (p < 0.05), respectively. CONCLUSION: Inexpensive and simple interventions can improve the intelligibility of prescriptions and reduce medication errors. WHAT IS KNOWN: Medication errors are frequent in NICUs and prescription is one of the most critical steps. CPOE reduce prescription errors, but their implementation is not available everywhere. WHAT IS NEW: Preformatted medical order sheet coupled with an introductory course decrease medication errors in a NICU. Preformatted medical order sheet is an inexpensive and readily implemented alternative to CPOE.
The objective of this study was to assess whether the introduction of a new preformatted medical order sheet coupled with an introductory course affected prescription quality and the frequency of errors during the prescription stage in a neonatal intensive care unit (NICU). Two-phase observational study consisting of two consecutive 4-month phases: pre-intervention (phase 0) and post-intervention (phase I) conducted in an 11-bed NICU in a Swiss university hospital. Interventions consisted of the introduction of a new preformatted medical order sheet with explicit information supplied, coupled with a staff introductory course on appropriate prescription and medication errors. The main outcomes measured were formal aspects of prescription and frequency and nature of prescription errors. Eighty-three and 81 patients were included in phase 0 and phase I, respectively. A total of 505 handwritten prescriptions in phase 0 and 525 in phase I were analysed. The rate of prescription errors decreased significantly from 28.9% in phase 0 to 13.5% in phase I (p < 0.05). Compared with phase 0, dose errors, name confusion and errors in frequency and rate of drug administration decreased in phase I, from 5.4 to 2.7% (p < 0.05), 5.9 to 0.2% (p < 0.05), 3.6 to 0.2% (p < 0.05), and 4.7 to 2.1% (p < 0.05), respectively. The rate of incomplete and ambiguous prescriptions decreased from 44.2 to 25.7 and 8.5 to 3.2% (p < 0.05), respectively. CONCLUSION: Inexpensive and simple interventions can improve the intelligibility of prescriptions and reduce medication errors. WHAT IS KNOWN: Medication errors are frequent in NICUs and prescription is one of the most critical steps. CPOE reduce prescription errors, but their implementation is not available everywhere. WHAT IS NEW: Preformatted medical order sheet coupled with an introductory course decrease medication errors in a NICU. Preformatted medical order sheet is an inexpensive and readily implemented alternative to CPOE.
Entities:
Keywords:
Drug medication error; Drug prescription; Intensive care unit; Newborn; Quality
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