Impact of an intervention to reduce prescribing errors in a pediatric intensive care unit.
OBJECTIVE
To identify and reduce medication prescribing errors in a pediatric intensive care unit (PICU) by means of an educational program designed to improve medical prescriptions.


METHODS
Before-after interventional study in a tertiary-level PICU. Handwritten prescriptions were prospectively collected: 2,228 during period 1 and 1,791 during period 2. In both periods elements of good prescribing practice including error indicators and quality indicators were studied. The interventional program included four measures: standardization of prescription sources, pocket tables with dosing guidelines, an updated prescription protocol, and an educational program on correct prescribing.


RESULTS
The prescribing error (PE) rate decreased from 34.2 to 21.7 % after the intervention. Lack of administration route was considered separately for its high prevalence, 30 and 20.8 % of prescriptions, respectively. The most frequent error was presence of some illegible element (59 %). Legibility was the element of prescription experiencing the greatest reduction in error rate, from 4.1 % of prescriptions with one or more illegible elements in period 1 to 0.2 % in period 2. Tenfold overdosage decreased from two cases in period 1 to one case in period 2. The attending physician and on-call physician were associated with more PEs in both periods. The number of prescriptions with two or more errors decreased from 3.1 to 0.7 %. Errors reaching the patient were scarce, 14 (0.63 %) in period 1 and 6 (0.34 %) in period 2, without adverse events.


CONCLUSIONS
Implementation of an educational program for physicians may significantly reduce the prescribing error rate in a PICU.
Department of Pediatrics, Pediatric Critical Care Unit, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040, Madrid, Spain. amartinezanton@yahoo.es
Amalia
A
Martinez-Anton
J Ignacio
JI
Sanchez
Lidia
L
Casanueva
D006801:Humans; D015994:Incidence; D015278:Intensive Care Units, Pediatric; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010372:Pediatrics; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D013030:Spain