title: Interventions to reduce medication errors in pediatric intensive care.
abstract: OBJECTIVE
  To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units.
  
  
  METHODS
  Databases were searched from inception to April 2014.
  
  
  METHODS
  Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors.
  
  
  RESULTS
  In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ(2)(5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79); IS: 0.37 (95% CI = 0.19, 0.73); ME: 0.36 (95% CI = 0.22, 0.58); PG: 0.82 (95% CI = 0.21, 3.25); PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03).
  
  
  CONCLUSIONS
  Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions.
authors: Deakin University, Burwood, VIC, Australia The University of Melbourne, Parkville, VIC, Australia emanias@deakin.edu.au.
authors: Elizabeth
authors: E
authors: Manias
authors: The University of Melbourne, Parkville, VIC, Australia Royal Children's Hospital, Parkville, VIC, Australia.
authors: Sharon
authors: S
authors: Kinney
authors: The University of Melbourne, Parkville, VIC, Australia Royal Children's Hospital, Parkville, VIC, Australia.
authors: Noel
authors: N
authors: Cranswick
authors: Monash University, Clayton, VIC, Australia.
authors: Allison
authors: A
authors: Williams
authors: Griffith University, Brisbane, QLD, Australia.
authors: Narelle
authors: N
authors: Borrott
mesh_terms: D002648:Child; D020000:Decision Support Systems, Clinical; D006282:Health Personnel / Q000193:education; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000458:organization & administration; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008510:Medication Systems, Hospital / Q000458:organization & administration; D010595:Pharmacists; D010820:Physicians; D012107:Research Design
keywords: clinical practice; critical care; medication errors; medication safety; pediatrics