The Impact of Technology on Medication Safety in Paediatric Critical care

<div>Introduction:</div><div>Evidence for the benefits of health information technology (HIT) in the paediatric</div><div>setting is currently limited. In 2012, electronic-prescribing, standardised</div><div>concentration infusions (SCIs) and smart-pump technology were implemented into</div><div>the paediatric critical care unit (PCCU) in Our Lady’s Children’s Hospital, Crumlin.</div><div>Aim:</div><div>To assess the impact of this new HIT on PCCU medication errors.</div><div>Methodology:</div><div>A Delphi consensus process developed a list of novel or previously unaddressed</div><div>medication errors. The results, combined with published medication errors</div><div>definitions, were applied to three further studies: a before and after study of</div><div>clinical pharmacist interventions; the direct observation of smart-pump infusions; a</div><div>retrospective review of hospital voluntary incident reports. The respective focus of</div><div>each study was prescribing errors, smart-pump-related administration errors, and</div><div>potentially severe infusion-related errors. Ethics approval was granted or waived</div><div>for each study. Data analysis and statistically tests were performed using</div><div>Microsoft Excel® and STATA® (Version 13.1).</div><div>Results:</div><div>The Delphi panel determined that 14 of 17 scenarios be included as medication</div><div>errors; reaching consensus on electronic-prescribing scenarios was most difficult.</div><div>Overall medication error rates were unchanged on implementation of electronicprescribing</div><div>(10.2% v 9.8%, p=0.99). Altered error distribution was evident.</div><div>Implementing SCIs reduced paper-based infusion errors (29% to 14.6%,</div><div>p<0.001), with a further non-significant reduction identified with electronic infusionorders</div><div>(8.4%, p>0.05). Direct observation identified medication errors in 5.4% of</div><div>infusions (n=1023). Programming errors were uncommon (1.6%). The benefits of</div><div>the pump-interface were demonstrated. Voluntary incident report review identified</div><div>more clinically significant errors (14.1% v ≤7%) than the other studies.</div><div>Technology-generated errors, and the capacity to engineer out errors with HIT</div><div>systems, were evident in all studies.</div><div>Conclusion:</div><div>The benefits of HIT in the complex PCCU setting have been demonstrated. SCIs</div><div>and smart-pumps increase the safety of paediatric infusions. Reducing overall</div><div>prescribing errors with electronic-prescribing is more difficult to achieve.</div>