The Impact of Technology on Medication Safety in Paediatric Critical care

Introduction:

Evidence for the benefits of health information technology (HIT) in the paediatric

setting is currently limited. In 2012, electronic-prescribing, standardised

concentration infusions (SCIs) and smart-pump technology were implemented into

the paediatric critical care unit (PCCU) in Our Lady’s Children’s Hospital, Crumlin.

Aim:

To assess the impact of this new HIT on PCCU medication errors.

Methodology:

A Delphi consensus process developed a list of novel or previously unaddressed

medication errors. The results, combined with published medication errors

definitions, were applied to three further studies: a before and after study of

clinical pharmacist interventions; the direct observation of smart-pump infusions; a

retrospective review of hospital voluntary incident reports. The respective focus of

each study was prescribing errors, smart-pump-related administration errors, and

potentially severe infusion-related errors. Ethics approval was granted or waived

for each study. Data analysis and statistically tests were performed using

Microsoft Excel® and STATA® (Version 13.1).

Results:

The Delphi panel determined that 14 of 17 scenarios be included as medication

errors; reaching consensus on electronic-prescribing scenarios was most difficult.

Overall medication error rates were unchanged on implementation of electronicprescribing

(10.2% v 9.8%, p=0.99). Altered error distribution was evident.

Implementing SCIs reduced paper-based infusion errors (29% to 14.6%,

p<0.001), with a further non-significant reduction identified with electronic infusionorders

(8.4%, p>0.05). Direct observation identified medication errors in 5.4% of

infusions (n=1023). Programming errors were uncommon (1.6%). The benefits of

the pump-interface were demonstrated. Voluntary incident report review identified

more clinically significant errors (14.1% v ≤7%) than the other studies.

Technology-generated errors, and the capacity to engineer out errors with HIT

systems, were evident in all studies.

Conclusion:

The benefits of HIT in the complex PCCU setting have been demonstrated. SCIs

and smart-pumps increase the safety of paediatric infusions. Reducing overall

prescribing errors with electronic-prescribing is more difficult to achieve.