An Observational Study of the Role of the Paediatric Clinical Pharmacist

Conroy, Sharon; Alsenani, Ahmed; Sammons, Helen

doi:10.1136/archdischild-2015-308634.14

Arch Dis Child

2015

DOI: 10.1136/archdischild-2015-308634.14

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An Observational Study of the Role of the Paediatric Clinical Pharmacist

Sharon Conroy

Ahmed Alsenani

Helen Sammons

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2018

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“…Pharmacists have been identified as being able to support nurses by taking on medicines management tasks alongside traditional nursing responsibilities such as medicines administration and discharge planning. 1 At Barts Health NHS Trust there was increased pressure on nursing staff particularly on one of the complex medical wards during the winter pressure months. Paediatric pharmacists were identified as being able to support nurse:…”

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confidence: 99%

P30 The effects of introducing electronic prescribing for paediatric chemotherapy using aria on prescribing error rates at a primary treatment centre

Cook

Fox

2018

Arch Dis Child

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IntroductionPrescribing of medication in children is a very complex process that involves an understanding of paediatric physiology, disease states, medication used and pharmacokinetics as well as patient specific details, their co-morbidities and their clinical condition. The most common medication errors have been identified as dosing, route of administration, and frequency of administration. Computerised provider order entry has been shown to reduce the number of prescribing errors related to chemotherapy as well as the likelihood of dose and calculation errors in paediatric chemotherapy prescribing. Locally, paediatric chemotherapy is prescribed on pre-printed paper prescriptions. Adaptation and implementation of ARIA electronic prescribing (EP) system for use in paediatric chemotherapy was undertaken by a Specialist Paediatric Oncology Pharmacist and was rolled out for use in January 2016 for patients with acute lymphoblastic leukaemia.MethodThe United Kingdom National Randomised Trial for Children and Young Adults with Acute Lymphoblastic Leukaemia and Lymphoma 2011 (UKALL, 2011) was developed for use on EP, with prescribing of all other chemotherapy remaining on paper. The number and type of prescribing errors were collected during a pre-implementation phase from January 2015 to June 2015. After the introduction of EP and following a 2 month acclimatisation period, a second period of data collection took place between March 2016 and July 2016. Overall prescribing error rates and the frequency of each error type were calculated both before and after implementation.ResultsBefore the introduction of EP for paediatric chemotherapy, the overall error rate was 18.4% with a total of 16 different errors seen. Post implementation, overall error rate increased to 25.7% (p<0.001) with a total of 10 different errors seen. After introduction of EP, prescribing error rates on paper were 30.6% and on EP were 7.0% (p<0.001). Only 5 different error types were seen with electronic prescribing. The most commonly seen errors in prescribing with paper, both before and after were almost eliminated with the introduction of EP.ConclusionThe introduction of EP has resulted in a significant reduction in prescribing error rates compared to paper based prescribing for paediatric chemotherapy. Overall the prescribing error rate increased after the introduction of EP but this was related to an increased rate on the paper prescriptions. One possible reason for this was the use of dual systems for prescribing. In addition there was unforeseen relocation and building work within the paediatric cancer unit, which affected prescribing time allocation. There were also several staff shortages within the prescribing team after implementation and this resulted in an increased workload on the remaining chemotherapy prescribers. All these issues could have attributed to the increase in error rates. The most common errors seen with chemotherapy prescribing have been reduced with EP as protocols have been developed with a focus on prescribing safety...

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confidence: 99%

P30 The effects of introducing electronic prescribing for paediatric chemotherapy using aria on prescribing error rates at a primary treatment centre

Cook

Fox

2018

Arch Dis Child

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P31 The effect of electronic prescribing on the incidence and nature of paediatric medication errors – an observational study

2018

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BackgroundPrescribing errors may adversely affect the safety of patients of all ages and particularly paediatric patients due to the complexity of calculating individual patient doses and the common need to use medicines not designed for children.Electronic prescribing systems (EPS) are an intervention used to try reduce such errors. Few studies have evaluated their impact on prescribing errors in the UK particularly in neonatal/paediatric settings.AimsTo evaluate the nature and prevalence of prescribing errors in a UK children’s hospital which uses an EPS.To compare the results with those of a previous study1 conducted in the same hospital before the introduction of EPS.MethodsPharmacists were shadowed in their routine clinical work by the researcher who documented all prescribing errors identified. All electronic prescriptions checked for patients≤18 years in the paediatric wards were included in the data collection. Data was entered into a SPSS database for analysis.Types and severity of errors identified were categorised according to criteria used in a previous General Medical Council funded study (EQUIP).2 Results were compared to a previous study from 2012/2013 in the same hospital (4204 prescriptions) using the same method before the introduction of EPS.ResultsObservation of 4035 prescriptions checked by pharmacists on their routine ward visits (754 patients) during September-December 2015 identified 208 prescribing errors, an error rate of 5.2% prescriptions.There was a statistically significant difference between the rate of errors identified in this study compared to that found in the written prescriptions (8.7%) in the previous study (p<0.001).Fifteen errors (7.2%) were classified as serious; 106 errors (51%) significant and minor errors represented the remaining errors (data unavailable for previous study).The most common types of error identified were omission of regular medications (1.7% total prescriptions vs 1.6% in previous study); under-doses (0.8% vs 0.7%), non-measurable doses (0.7% vs 1.5%) and overdoses (0.5% vs 0.7%). Illegible prescriptions were reduced from 2% total prescriptions in the first study to zero by the EPS. Errors involving incorrect/missing administration times were also reduced from 0.9% in the previous study to 0.2% in this study.Antibacterial, analgesics and bronchodilators were the most common groups of drugs associated with errors (28.8%, 10.6% and 10.6% of total errors respectively). The oral route was most commonly involved in errors (47.2% of total errors) followed by intravenous (30.3%) (data unavailable for previous study).ConclusionThe EPS was associated with a significant reduction in prescribing errors compared with written prescriptions. Illegible prescription errors were eliminated and incorrect/missing administration time errors greatly reduced. Errors involving non-measurable doses were more than halved. EPS however had a negligible effect on under- and over-dosing errors. Introduction of a more sophisticated clinical decision support system may help to reduce ...

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An Observational Study of the Role of the Paediatric Clinical Pharmacist

Cited by 2 publications

References 1 publication

P30 The effects of introducing electronic prescribing for paediatric chemotherapy using aria on prescribing error rates at a primary treatment centre

P30 The effects of introducing electronic prescribing for paediatric chemotherapy using aria on prescribing error rates at a primary treatment centre

P31 The effect of electronic prescribing on the incidence and nature of paediatric medication errors – an observational study

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