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The Impact of Technology on Medication Safety in Paediatric Critical care

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posted on 13.08.2020, 13:53 authored by Moninne HowlettMoninne Howlett
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.
To assess the impact of this new HIT on PCCU medication errors.
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).
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.
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.


First Supervisor

Prof Brian Cleary

Second Supervisor

Prof Paul Gallagher

Third Supervisor

Dr Cormac Breatnach


A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2019.

Published Citation

Howlett M. The Impact of Technology on Medication Safety in Paediatric Critical care [PhD Thesis] Dublin: Royal College of Surgeons in Ireland; 2019.

Degree Name

Doctor of Philosophy (PhD)

Date of award



  • Doctor of Philosophy (PhD)

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