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Can electronic prescribing prevent harmful paediatric prescribing errors?

Student thesis: Doctoral Thesis

Introduction
Electronic prescribing (EP) has been shown to be effective in reducing prescribing errors in a range of settings including paediatrics. However, the lack of a consistent definition of error and a variety of error detection methods makes it difficult to draw conclusions about the impact on patients. An ability to clearly understand and consistently measure how EP systems can prevent harmful prescribing errors in children is, therefore, required. In addition, an evaluation of a range of EP systems in current use can help to gain an understanding of how to improve EP in the future. The aims of this work were to: firstly develop a range of paediatric prescribing indicators that are likely to cause harm if prescribed. Secondly, test a range of EP and clinical decision support (CDS) systems currently in use for their ability to prevent the errors described by the paediatric prescribing indicators.

Method
An eDelphi consensus study was carried out with 21 expert panellists from the UK. Panellists were asked to score each prescribing error for its likelihood of occurrence and severity of outcome should the error occur. Indicators were included in the final list if a consensus of 80% or higher was achieved and were in the high risk categories. The indicators were then sent to a group of hospitals using EP in their paediatric departments. The paediatric pharmacists simulated the indicators in their EP systems and provided feedback on whether the error could be prescribed and what level of CDS was presented to the prescriber during the prescribing process.


Results
In the consensus process two rounds of scoring took place. These identified 41 paediatric prescribing indicators with a high risk rating and greater than 80% consensus. The most common error type within the indicators was dose (n = 19) and the most common drug classes were antimicrobial (n = 10) and cardiovascular (n = 7). The indicators were converted into a set of prescribing errors which were then tested using eight different EP systems across 15 different sites. In 90% of tests the error was permitted by the EP system i.e. it was possible to prescribe the error. Levels of CDS varied, both between different systems and the same system at different sites. Allergy, drug name and therapeutic duplication errors were most likely to be prevented by the CDS. Drug-drug interactions, clinical contraindications and duration errors were least likely to be prevented.
Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award date2018

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