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Intercepting Medication Errors in Pediatric In-patients Using a Prescription Pre-audit Intelligent Decision System: A Single-center Study

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Abstract

Objectives

Medication errors can happen at any phase of the medication process at health care settings. The objective of this study is to identify the characteristics of severe prescribing errors at a pediatric hospital in the inpatient setting and to provide recommendations to improve medication safety and rational drug use.

Methods

This descriptive retrospective study was conducted at a tertiary pediatric hospital using data collected from Jan. 1st, 2019 to Dec. 31st, 2020. During this period, the Prescription Pre-audit Intelligent Decision System was implemented. Medication orders with potential severe errors would trigger a Level 7 alert and would be intercepted before it reached the pharmacy. Trained pharmacists maintained the system and facilitated decision making when necessary. For each order intercepted by the system the following patient details were recorded and analyzed: patient age, patient’s department, drug classification, dosage forms, route of administration, and the type of error.

Results

A total of 2176 Level 7 medication orders were intercepted. The most common errors were associated with drug dosage, administration route, and dose frequency, accounting for 35.2%, 32.8% and 13.2%, respectively. Of all the intercepted oerrors. 53.6% occurred in infants aged < 1 year. Administration routes involved were mainly intravenous, oral and external use drugs. Most alerts came from the neonatology department and constituted 40.5% of the total alerts, followed by the nephrology department 15.9% and pediatric intensive care unit (PICU) 11.3%. As to dosage forms, injections accounted for 50.4% of alerts, with 21.3% attributable to topical solutions, 9.1% to tablets, and 5.7% to inhalation. Anti-infective agents were the most common therapeutic drugs prescribed with errors.

Conclusions

The Prescription Pre-audit Intelligent Decision System, with the supervision of trained pharmacists can validate prescriptions, increase prescription accuracy, and improve drug safety for hospitalized children. It is a medical service model worthy of consideration.

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Acknowledgements

The authors thank all the clinical pharmacists at the Children’s Hospital of Fudan University for prescription checking.

Author information

Author notes

  1. Guangfei Wang and Feng Zheng contributed equally to this work.

Authors and Affiliations

  1. Department of Clinical Pharmacy, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, 201102, China

    Guangfei Wang, Feng Zheng, Yidie Huang, Qiaofeng Ye, Xunjie Zhang, Ying Xu, Xuhui Zhang & Zhiping Li

  2. School of Pharmacy, Fudan University, Shanghai, 201203, China

    Guiyao Zhang

  3. Department of Biology, University of California Santa Barbara, Santa Barbara, California, USA

    Xuyuan Li

  4. Department of Respiratory Disease, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, 201102, China

    Xiaobo Zhang

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  1. Guangfei Wang
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Contributions

GFW designed the study, analyzed the data, drafted the initial manuscript, and revised the manuscript. GYZ, YX, FZ, XHZ and YDH collected the data and searched the literature. XJZ, QFY and XYL revised the manuscript. ZPL and XBZ designed the study and acquired funding. All authors agreed on the journal to which the article was submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Xiaobo Zhang or Zhiping Li.

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Funding

This study was supported by the National Natural Science Foundation of China (No. 81874325), Scientific Research Project of Science and Technology Commission of Shanghai Municipality (No.18DZ1910604).

Conflict of interest

The authors have no other conflicts of interest to declare. No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Ethics approval

This study protocol follows the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Ethics Committee of Children’s Hospital of Fudan University. This study was exempted from written form informed consent due to its retrospective nature.

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Availability of data and material

All the original data for this study can be accessed by contacting the corresponding author.

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Wang, G., Zheng, F., Zhang, G. et al. Intercepting Medication Errors in Pediatric In-patients Using a Prescription Pre-audit Intelligent Decision System: A Single-center Study. Pediatr Drugs 24, 555–562 (2022). https://doi.org/10.1007/s40272-022-00521-2

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