G21(P) Prescribing errors on a general paediatric ward: what's next?. (May 2019)

• Record Type: Journal Article
• Authors: Raja, K; Julies, P; Moreno, A; Ocansey, M; Omar, I
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 2
• Page Start: A9
• Page End: A9
• Publication Date: 2019-05
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-rcpch.21
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Prescribing errors are the most common form of medication errors with potential to cause harm, especially in paediatrics. We previously highlighted common prescribing errors on our paediatric ward, which improved with dedicated weekly Druggles, educating junior doctors and empowering nursing staff to identify errors. Our aim was to review whether these improvements were sustained and to report further prescribing errors for intervention. Methods: Data relating to drug prescribing errors in inpatients was collected prospectively by the ward pharmacist once weekly from April to September 2018. The multi-disciplinary team continued to use the Model for Improvement to test existing interventions. Repeated PDSA cycles identified and tested further interventions based on the most common errors noted. These included piloting ibuprofen and paracetamol dosing cards distributed to juniors on lanyards, and also attached to each patient bedside folder. New surgical junior doctors received a brief teaching session on paediatric prescribing at their August 2018 induction with a handout. Weekly Druggles were continued and learning disseminated via email to paediatric consultants and junior doctors. Results: A total of 76 prescribing errors was reported. The most frequent were incorrect dose prescribing (n=25, 33%) and lack of documentation of frequency of medications (n=20, 26%). Over half of all errors (n=38, 54%) were made were by surgical junior doctors, mainly relating to prescription of analgesia and anti-emetics. There was good engagement from all members of the improvement team and ward managers. Interventions were well-received by recipients, particularly dosing cards. Re-introduction of the prescribing checklist Druggle led to improved documentation of allergies and signatures from 20% (8/40) during the previous data collection period to 6.5% (5/76). Following the introduction of analgesia dosing cards in week 12, there have been no ibuprofen prescribing errors by paediatric doctors. Conclusion: Weekly Druggles with shared learning and dosing cards have helped improve prescribing by paediatric staff. Further interventions targeted at surgical and paediatric doctors are planned to further embed safe prescribing practice across specialties. These include creating two quiet 'prescribing areas' on the ward with poster-displays highlighting prescription of common analgesics and anti-emetics.