Joachim A Koeck1, Nicola J Young2, Udo Kontny3, Thorsten Orlikowsky4, Dirk Bassler5, Albrecht Eisert2,6. 1. Hospital Pharmacy, RWTH Aachen University Hospital, Steinbergweg 20, 52074, Aachen, Germany. jkoeck@ukaachen.de. 2. Hospital Pharmacy, RWTH Aachen University Hospital, Steinbergweg 20, 52074, Aachen, Germany. 3. Section of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatric and Adolescent Medicine, RWTH Aachen University Hospital, Aachen, Germany. 4. Section of Neonatology, Department of Pediatric and Adolescent Medicine, RWTH Aachen University Hospital, Aachen, Germany. 5. Department of Neonatology, University Hospital Zurich, Zurich, Switzerland. 6. Institute of Clinical Pharmacology, RWTH Aachen University Hospital, Aachen, Germany.
Abstract
INTRODUCTION: Pediatric medication therapy is prone to errors due to the need for pharmacokinetic and pharmacodynamic individualization and the diverse settings in which pediatric patients are treated. Prescribing errors have been reported as the most common medication error. OBJECTIVES: The aim of this review was to systematically identify interventions to reduce prescribing errors and corresponding patient harm in pediatric healthcare settings and to evaluate their impact. METHODS: Four databases were systematically screened (time range November 2011 to December 2019), and experimental studies were included. Interventions to reduce prescribing errors were extracted and classified according to a 'hierarchy of controls' model. RESULTS: Forty-five studies were included, and 70 individual interventions were identified. A bundle of interventions was more likely to reduce prescribing errors than a single intervention. Interventions classified as 'substitution or engineering controls' were more likely to reduce errors in comparison with 'administrative controls', as is expected from the hierarchy of controls model. Fourteen interventions were classified as substitution or engineering controls, including computerized physician order entry (CPOE) and clinical decision support (CDS) systems. Administrative controls, including education, expert consultations, and guidelines, were more commonly identified than higher level controls, although they may be less likely to reduce errors. Of the administrative controls, expert consultations were most likely to reduce errors. CONCLUSIONS: Interventions to reduce pediatric prescribing errors are more likely to be successful when implemented as part of a bundle of interventions. Interventions including CPOE and CDS that substitute risks or provide engineering controls should be prioritized and implemented with appropriate administrative controls including expert consultation.
INTRODUCTION: Pediatric medication therapy is prone to errors due to the need for pharmacokinetic and pharmacodynamic individualization and the diverse settings in which pediatric patients are treated. Prescribing errors have been reported as the most common medication error. OBJECTIVES: The aim of this review was to systematically identify interventions to reduce prescribing errors and corresponding patient harm in pediatric healthcare settings and to evaluate their impact. METHODS: Four databases were systematically screened (time range November 2011 to December 2019), and experimental studies were included. Interventions to reduce prescribing errors were extracted and classified according to a 'hierarchy of controls' model. RESULTS: Forty-five studies were included, and 70 individual interventions were identified. A bundle of interventions was more likely to reduce prescribing errors than a single intervention. Interventions classified as 'substitution or engineering controls' were more likely to reduce errors in comparison with 'administrative controls', as is expected from the hierarchy of controls model. Fourteen interventions were classified as substitution or engineering controls, including computerized physician order entry (CPOE) and clinical decision support (CDS) systems. Administrative controls, including education, expert consultations, and guidelines, were more commonly identified than higher level controls, although they may be less likely to reduce errors. Of the administrative controls, expert consultations were most likely to reduce errors. CONCLUSIONS: Interventions to reduce pediatric prescribing errors are more likely to be successful when implemented as part of a bundle of interventions. Interventions including CPOE and CDS that substitute risks or provide engineering controls should be prioritized and implemented with appropriate administrative controls including expert consultation.
Authors: Antonio Pintor-Mármol; María Isabel Baena; Paloma C Fajardo; Daniel Sabater-Hernández; Loreto Sáez-Benito; María Victoria García-Cárdenas; Narjis Fikri-Benbrahim; Inés Azpilicueta; Maria José Faus Journal: Pharmacoepidemiol Drug Saf Date: 2012-06-08 Impact factor: 2.890
Authors: Michael L Rinke; David G Bundy; Christina A Velasquez; Sandesh Rao; Yasmin Zerhouni; Katie Lobner; Jaime F Blanck; Marlene R Miller Journal: Pediatrics Date: 2014-07-14 Impact factor: 7.124
Authors: Nadia Roumeliotis; Jonathan Sniderman; Thomasin Adams-Webber; Newton Addo; Vijay Anand; Paula Rochon; Anna Taddio; Christopher Parshuram Journal: J Gen Intern Med Date: 2019-08-08 Impact factor: 5.128