title: Frequency of dosage prescribing medication errors associated with manual prescriptions for very preterm infants.
abstract: OBJECTIVE
  The risk of dosage Prescription Medication Error (PME) among manually written prescriptions within 'mixed' prescribing system (computerized physician order entry (CPOE) + manual prescriptions) has not been previously assessed in neonatology. This study aimed to evaluate the rate of dosage PME related to manual prescriptions in the high-risk population of very preterm infants (GA < 33 weeks) in a mixed prescription system.
  
  
  METHODS
  The study was based on a retrospective review of a random sample of manual daily prescriptions in two neonatal intensive care units (NICU) A and B, located in different French University hospitals (Dijon and La Reunion island). Daily prescription was defined as the set of all drugs manually prescribed on a single day for one patient. Dosage error was defined as a deviation of at least ±10% from the weight-appropriate recommended dose.
  
  
  CONCLUSIONS
  The analyses were based on the assessment of 676 manually prescribed drugs from NICU A (58 different drugs from 93 newborns and 240 daily prescriptions) and 354 manually prescribed drugs from NICU B (73 different drugs from 131 newborns and 241 daily prescriptions). The dosage error rate per 100 manually prescribed drugs was similar in both NICU: 3·8% (95% CI: 2·5-5·6%) in NICU A and 3·1% (95% CI: 1·6-5·5%) in NICU B (P = 0·54). Among all the 37 identified dosage errors, the over-dosing was almost as frequent as the under-dosing (17 and 20 errors, respectively). Potentially severe dosage errors occurred in a total of seven drug prescriptions. None of the dosage PME was recorded in the corresponding medical files and information on clinical outcome was not sufficient to identify clinical conditions related to dosage PME. Overall, 46·8% of manually prescribed drugs were off label or unlicensed, with no significant differences between prescriptions with or without dosage error. The risk of a dosage PME increased significantly if the drug was included in the CPOE system but was manually prescribed (OR = 3·3; 95% CI: 1·6-7·0, P < 0·001).
  
  
  CONCLUSIONS
  The presence of dosage PME in the manual prescriptions written within mixed prescription systems suggests that manual prescriptions should be totally avoided in neonatal units.
authors: Pediatrics, Centre d'Etudes Périnatales de l'Océan Indien (CEPOI), CHU de La Réunion, Saint-Pierre, Réunion.
authors: J
authors: J
authors: Horri
authors: A
authors: A
authors: Cransac
authors: C
authors: C
authors: Quantin
authors: M
authors: M
authors: Abrahamowicz
authors: C
authors: C
authors: Ferdynus
authors: C
authors: C
authors: Sgro
authors: P-Y
authors: PY
authors: Robillard
authors: S
authors: S
authors: Iacobelli
authors: J-B
authors: JB
authors: Gouyon
mesh_terms: D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000706:statistics & numerical data*; D056687:Off-Label Use / Q000706:statistics & numerical data; D010865:Pilot Projects; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D055553:Prescription Drugs
keywords: computerised decision support; drug utilisation; premature infants; prescription