Prescribing errors in a pediatric emergency department.
OBJECTIVE
To determine the frequency, prescriber, and type of prescribing errors in written in-house orders and ambulatory prescriptions in a pediatric emergency department (PED).


METHODS
A 17-day retrospective chart review and a 6-month retrospective ambulatory prescription review in a PED for medications with weight-based dosing. Orders and prescriptions were checked for prescriber identification number, route, weight-based target dose in milligrams per kilogram, frequency, correct dosing, and drug allergies. Narcotics were excluded from the prescription analysis.


RESULTS
Forty-seven (12.5%) of 377 in-house orders and 37 (19.4%) of 191 individual charts contained at least 1 error: 4 (1.1%) orders contained an incorrect dose, 41 (10.8%) were written incorrectly, and 2 (0.5%) contained an incorrect dose and were written incorrectly. Thirty (4.3%) of 696 ambulatory prescriptions contained 1 error: 14 (2.0%) contained an incorrect dose, and 16 (2.3%) were written incorrectly. Pediatric postgraduate year-3 residents had the highest in-house order incorrect dose error rate (1 of 29 orders or 3.5%), and ED pediatric postgraduate year-2 residents had the highest ambulatory prescription incorrect dose error rate (6 of 66 prescriptions or 9.1%). Pediatric ED attending physicians had the highest error rates for writing orders and prescriptions incorrectly, 25% (3 of 12) and 9.7% (3 of 31), respectively. Antibiotics, analgesics, and narcotics were most often involved in errors.


CONCLUSIONS
Prescribing errors are common in both written in-house orders and ambulatory prescriptions in a PED. Targeting safety interventions toward groups with less practice in prescribing pediatric doses and reeducating groups on safe medication writing techniques could decrease this error rate.
Rinke
Michael L
ML
Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.
Moon
Margaret
M
Clark
John S
JS
Mudd
Shawna
S
Miller
Marlene R
MR
D000046:Academic Medical Centers; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008508:Medication Errors / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment