A bundle with a preformatted medical order sheet and an introductory course to reduce prescription errors in neonates.
The objective of this study was to assess whether the introduction of a new preformatted medical order sheet coupled with an introductory course affected prescription quality and the frequency of errors during the prescription stage in a neonatal intensive care unit (NICU). Two-phase observational study consisting of two consecutive 4-month phases: pre-intervention (phase 0) and post-intervention (phase I) conducted in an 11-bed NICU in a Swiss university hospital. Interventions consisted of the introduction of a new preformatted medical order sheet with explicit information supplied, coupled with a staff introductory course on appropriate prescription and medication errors. The main outcomes measured were formal aspects of prescription and frequency and nature of prescription errors. Eighty-three and 81 patients were included in phase 0 and phase I, respectively. A total of 505 handwritten prescriptions in phase 0 and 525 in phase I were analysed. The rate of prescription errors decreased significantly from 28.9% in phase 0 to 13.5% in phase I (p < 0.05). Compared with phase 0, dose errors, name confusion and errors in frequency and rate of drug administration decreased in phase I, from 5.4 to 2.7% (p < 0.05), 5.9 to 0.2% (p < 0.05), 3.6 to 0.2% (p < 0.05), and 4.7 to 2.1% (p < 0.05), respectively. The rate of incomplete and ambiguous prescriptions decreased from 44.2 to 25.7 and 8.5 to 3.2% (p < 0.05), respectively.


CONCLUSIONS
Inexpensive and simple interventions can improve the intelligibility of prescriptions and reduce medication errors.


BACKGROUND
Medication errors are frequent in NICUs and prescription is one of the most critical steps. CPOE reduce prescription errors, but their implementation is not available everywhere.


BACKGROUND
Preformatted medical order sheet coupled with an introductory course decrease medication errors in a NICU. Preformatted medical order sheet is an inexpensive and readily implemented alternative to CPOE.
Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. david.palmero@chuv.ch.|Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. david.palmero@chuv.ch.|School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland. david.palmero@chuv.ch.
David
D
Palmero
Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. Ermindo.Di-Paolo@chuv.ch.
Ermindo R
ER
Di Paolo
Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. lydie@beauport.eu.
Lydie
L
Beauport
Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. Andre.Pannatier@chuv.ch.
André
A
Pannatier
Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. Jean-Francois.Tolsa@chuv.ch.
Jean-François
JF
Tolsa
D005568:Forms and Records Control / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008508:Medication Errors / Q000517:prevention & control*; D055656:Prescriptions / Q000592:standards*
Drug medication error; Drug prescription; Intensive care unit; Newborn; Quality