THE EFFECT OF A SHORT TUTORIAL ON THE INCIDENCE OF PRESCRIBING ERRORS IN PEDIATRIC EMERGENCY CARE

Main Article Content

Eran Kozer Kozer
Dennis Scolnik
Alison Macpherson
David Rauchwerger
Gideon Koren

Keywords

Emergency medicine, medication errors, paediatrics, education

Abstract

Background


In the paediatric emergency department (ED) trainees are more likely to commit prescribing errors.


 Objective


To determine whether a short educational intervention reduces the incidence of prescribing errors among trainees in a pediatric ED.


 Methods


A prospective cohort study at the ED of a tertiary paediatric hospital. All fellows and residents arriving at the ED at the beginning of the academic year were invited to participate in a 30-minute tutorial focusing on appropriate methods for prescribing medications, followed by a written test. Eighteen days were selected randomly during July 2001. All the charts from these days were reviewed for medication errors. Two reviewers, blinded to whether or not a particular physician attended the tutorial, independently decided whether or not an error had occurred. The main outcome measure was the number of prescribing errors.


 Results


Twenty-two trainees worked in the ED during July 2001. Of these, 13 trainees attended the tutorial. Eight hundred and ninety nine orders given by trainees were evaluated. We identified 66 (12.4%) errors in 533 orders given by those who attended tutorial, and 46 (12.7%) errors in 363 orders given by those who did not attend tutorial. The adjusted odds of a medication error was not significantly different between those who did not attend the tutorial and those who did (OR: 1.07 95% CI: 0.66-1.70).


 Conclusions


A short tutorial, followed by a written test, administered to trainees before entering their rotation in the paediatric ED, did not appear to reduce prescribing errors.

Abstract 561 | PDF Downloads 150

References

1. Kozer E, Scolnik D, Macpherson A, Keays T, Shi K, Luk T, et al. Variables associated with medication errors in pediatric emergency medicine. Pediatrics 2002; 110(4):737-742.
2. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274(1):29-34.
3. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991; 324(6):377-384.
4. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991; 324(6):370- 376.
5. Buehler JW, Smith LF, Wallace EM, Heath CW, Jr., Kusiak R, Herndon JL. Unexplained deaths in a children's hospital. An epidemiologic assessment. N Engl J Med 1985; 313(4):211-216.
6. Shaughnessy AF, D'Amico F. Long- term experience with a program to improve prescription- writing skills. Fam Med 1994; 26(3):168-171.
7. Nelson LS, Gordon PE, Simmons MD, Goldberg WL, Howland MA, Hoffman RS. The benefit of houseofficer education on proper medication dose calculation and ordering. Acad Emerg Med 2000; 7(11):1311-1316.
8. Kozer E, Scolnik D, Macpherson A, Rauchwerger D, Koren G. Using a Preprinted Order Sheet to Reduce Prescription Errors in a Pediatric Emergency Department: A Randomized Controlled Trial. Pediatrics 2005;116(6):1299- 302.
9. The 2000 -2001 Formulary of Drugs. 19th ed.Toronto: The Hospital for Sick Children, 2 000.
10. Compendium of pharmaceuticals and specialties.35 ed. Ottawa, Canada: Canadian Pharmacist Association, 2000.
11. Glover ML, Sussmane JB. Assessing pediatrics residents' mathematical skills for prescribing medication: a need for improved training. Acad Med 2002; 77(10):1007- 1010.
12. Rowe C, Koren T, Koren G. Errors by paediatric residents in calculating drug doses. Arch Dis Child 1998; 79(1):56- 58.
13. Boreham NC, Mawer GE, Foster RW. Medical students' errors in pharmacotherapeutics. Med Educ 2000; 34(3):188 -193.
14. Kraus DM, Stifter J, Hatoum HT. Program to improve nurses' knowledge of pediatric emergency medications. Am J Hosp Pharm 1991; 48(1):97-101.
15. Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet 2002; 359(9315):1373-1378.
16. Levine SR, Cohen MR, Blanchard NR, et al.Guidelines for preventing medication errors in pediatrics. J Pediatr Pharmacol Ther.2001; 6 :426 –442
17. Bayne T, Bindler R. Effectiveness of medication calculation enhancement metho ds with nurses. J Nurs Staff Dev 1997; 13(6):293-301.
18. Lesar TS, Briceland LL, Delcoure K, Parmalee JC, Masta -Gornic V, Pohl H. Medication prescribing errors in a teaching hospital. JAMA 1990; 263(17):2329-2334.
19. West DW, Levine S, Magram G, MacCorkle AH, Thomas P, Upp K. Pediatric medication order error rates related to the mode of order transmission. Arch Pediatr Adolesc Med 1994;148(12):1322-1326.
20. Potts MJ, Phelan KW. Deficiencies in calculation and applied mathematics skills in pediatrics among primary care interns. Arch Pediatr Adolesc Med 1996; 150(7):748 -752.
21. Kohn LT CJD Me. To err is human: building asafer health system. 2000. Washington, D.C.: National Academy Press.
22. Stucky ER. Prevention of medication errors in the pediatric inpatient setting. Pediatrics 2003; 112(2):431- 436.
23. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163(12):1409- 1416.
24. Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280(15):1311-1316.
25. King WJ, Paice N, Rangrej J, Forestell GJ, Swartz R. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003; 112(3 Pt 1):506-509.
26. Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children's hospitals. Pediatrics 1987; 79(5):718-722.
27. Fontan JE, Maneglier V, Nguyen VX, Loirat C, Brion F. Medication errors in hospitals: computerized unit dose drug dispensing system versus ward stock distribution system. Pharm World Sci 2003; 25(3):112-117.
28. Rothschild JM, Lee TH, Bae T, Bates DW. Clinician use of a palmtop drug reference guide. J Am Med Inform Assoc 2002; 9(3):223- 229.
29. Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics 2004; 113(1 Pt 1):59-63.
30. Kozer E, Seto W, Verjee Z, Parshuram C, Khattak S, Koren G et al. Prospective observational study on the incidence of medication errors during simulated resuscitation in a paediatric emergency department. BMJ 2004; 329(7478):1321.
31. Shah AN, Frush K, Luo X, Wears RL. Effect of an intervention standardization system on pediatric dosing and equipment size determination: a crossover trial involving simulated resuscitation events. Arch Pediatr Adolesc Med 2003; 157(3):229- 236.