title: Prospective, controlled study of an intervention to reduce errors in neonatal antibiotic orders.
abstract: OBJECTIVE
  To evaluate the effectiveness of an interactive computerized order set with decision support (ICOS-DS) in preventing medication errors in neonatal late-onset sepsis (LOS).
  
  
  METHODS
  Prospective, controlled comparison of error rates in antibiotic orders for neonates admitted to the Medical University of South Carolina neonatal intensive care unit with suspected LOS (after postnatal day of life 3) prior to (n=153) and after (n=146) implementation of the ICOS-DS. Antibiotic orders were independently evaluated by two pharmacists for prescribing errors, potential errors and omissions. Prescribing errors included>10% overdoses or underdoses, inappropriate route, schedule or antibiotic, drug-drug or drug-disease interactions, and incorrect patient demographics. Potential errors included misspelled drugs, leading decimals, trailing zeroes, impractical doses and error-prone abbreviations. Multiple errors and omissions in an order were counted individually.
  
  
  RESULTS
  Overall error rate per order decreased from 1.7 to 0.8 (P<0.001) and potential error rate from 1.0 to 0.06 (P<0.001). The reduction in omission error rate per order from 0.2 to 0.1 was not significant (P=0.17). The prescribing error rate per order increased from 0.4 to 0.7 (P=0.03) because of the use of incorrect patient weights (P<0.001). Renal dysfunction was significantly associated with an increased risk of prescribing errors (odds ratio=3.7, P=0.01) which was not significantly different for handwritten versus ICOS-DS orders (P=0.15).
  
  
  CONCLUSIONS
  The ICOS-DS significantly improved the quality of neonatal LOS antibiotic orders although the use of incorrect patient weights was increased. In both groups, orders for patients with renal dysfunction were at risk for prescribing errors. Further evaluation of interventions to promote medication safety for this population is needed.
authors.affiliation: 1] Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA [2] Center for Medication Safety, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA [3] Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA [4] Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Garner
authors.affiliation: 1] Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA [2] Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Cox
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: E G
authors.initials: EG
authors.lastname: Hill
authors.affiliation: Office of the Chief Medical Information Office, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Irving
authors.affiliation: Department of Nursing, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Bissinger
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Annibale
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D000067562:Late Onset Disorders / Q000188:drug therapy*; D008508:Medication Errors / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
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