title: Clinical pharmacy interventions in paediatric electronic prescriptions.
abstract: OBJECTIVE
  To examine the frequency, nature and determinants of clinical pharmacy interventions in paediatric electronic prescriptions.
  
  
  METHODS
  Prospective cohort with nested case-control study.
  
  
  METHODS
  Tertiary children's hospital, The Netherlands.
  
  
  METHODS
  Patients 0-18 years with at least one drug prescription admitted to hospital between 1 March 2004 and 1 January 2008, excluding patients receiving intensive care.
  
  
  METHODS
  Electronic medication prescriptions for paediatric inpatients were verified and if necessary interventions were made by the paediatric clinical pharmacy. Prescriptions requiring intervention (cases) were compared with prescriptions not requiring interventions (controls).
  
  
  METHODS
  Frequency of clinical pharmacy interventions, per 10 000 paediatric electronic prescriptions, and the determinants thereof.
  
  
  RESULTS
  Interventions were made for 1577 (1.1%) of 138 449 prescriptions. 81% of the interventions concerned correction of a prescription that might have had adverse clinical consequences. Interventions in prescriptions for antibacterial agents for systemic use were made most often. Most corrections concerned wrong doses (45%). 1577 cases were compared with 1983 controls. The risk of interventions was higher for children aged 1 month to 2 years than for 12-18-year-olds (OR=1.97 (95% CI 1.63 to 2.38)). The risk for 'free-text' prescriptions was five times higher than for 'standardised structured template' prescriptions. No differences were found between day, evening and night shift prescriptions. Significantly more interventions were made in the oral dosage form (OR=1.63 (95% CI 1.41 to 1.88)) and administration route (OR=1.80 (95% CI 1.55 to 2.09)) than for other reasons.
  
  
  CONCLUSIONS
  Paediatric prescribing errors occur frequently and are not completely prevented by electronic prescribing systems. This study provides information for improvements in electronic prescribing for paediatric patients. Incorporating tailored solutions, such as minimised free-text entry, certain obligatory fields and integrated dose checking and indications, can improve the quality and efficiency of electronic prescribing in paediatrics.
authors.affiliation: Department of Clinical Pharmacy, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands. B.Maat@umcutrecht.nl
authors.forename: Barbara
authors.initials: B
authors.lastname: Maat
authors.forename: Yuen San
authors.initials: YS
authors.lastname: Au
authors.forename: Casper W
authors.initials: CW
authors.lastname: Bollen
authors.forename: Adrianus J
authors.initials: AJ
authors.lastname: van Vught
authors.forename: Toine C G
authors.initials: TC
authors.lastname: Egberts
authors.forename: Carin M A
authors.initials: CM
authors.lastname: Rademaker
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D009426:Netherlands; D010595:Pharmacists / Q000706:statistics & numerical data*; D011446:Prospective Studies