title: Zero tolerance prescribing: a strategy to reduce prescribing errors on the paediatric intensive care unit.
abstract: OBJECTIVE
  To establish the baseline prescribing error rate in a tertiary paediatric intensive care unit (PICU) and to determine the impact of a zero tolerance prescribing (ZTP) policy incorporating a dedicated prescribing area and daily feedback of prescribing errors.
  
  
  METHODS
  A prospective, non-blinded, observational study was undertaken in a 12-bed tertiary PICU over a period of 134 weeks. Baseline prescribing error data were collected on weekdays for all patients for a period of 32 weeks, following which the ZTP policy was introduced. Daily error feedback was introduced after a further 12 months. Errors were sub-classified as 'clinical', 'non-clinical' and 'infusion prescription' errors and the effects of interventions considered separately.
  
  
  RESULTS
  The baseline combined prescribing error rate was 892 (95 % confidence interval (CI) 765-1,019) errors per 1,000 PICU occupied bed days (OBDs), comprising 25.6 % clinical, 44 % non-clinical and 30.4 % infusion prescription errors. The combined interventions of ZTP plus daily error feedback were associated with a reduction in the combined prescribing error rate to 447 (95 % CI 389-504) errors per 1,000 OBDs (p < 0.0001), an absolute risk reduction of 44.5 % (95 % CI 40.8-48.0 %). Introduction of the ZTP policy was associated with a significant decrease in clinical and infusion prescription errors, while the introduction of daily error feedback was associated with a significant reduction in non-clinical prescribing errors.
  
  
  CONCLUSIONS
  The combined interventions of ZTP and daily error feedback were associated with a significant reduction in prescribing errors in the PICU, in line with Department of Health requirements of a 40 % reduction within 5 years.
authors.affiliation: Pharmacy Department, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK. Rachelle.Booth@gosh.nhs.uk
authors.forename: Rachelle
authors.initials: R
authors.lastname: Booth
authors.forename: Emma
authors.initials: E
authors.lastname: Sturgess
authors.forename: Alison
authors.initials: A
authors.lastname: Taberner-Stokes
authors.forename: Mark
authors.initials: M
authors.lastname: Peters
mesh_terms: D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D005246:Feedback; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008509:Medication Systems; D011446:Prospective Studies; D058996:Quality Improvement; D006113:United Kingdom