Educational Interventions to Reduce Paediatric Prescribing Errors

Developing a climate for safe prescribing for children

“…In published research, prescribing education has taken the form of e-learning, tutorials, courses and posters8; in clinical practice, it typically involves pharmacist-led presentations during junior doctor inductions and, sometimes, written tests of competency 9. While these approaches may provide an important foundation (eg, that offered by the excellent Royal College of Paediatrics and Child Health (RCPCH) online module, paediatric prescribing principles), the context-dependent nature of error suggests that they are unlikely to improve practice on their own.…”

“…Stakeholders who take ownership of recommendations can adapt them to the local context and give useful advice to those who make recommendations.Small acts, such as a consultant proactively reviewing the BNFc on a ward round, can have significant positive impact on overall prescribing culture and practice.Prescribers can improve safety by being observant for small changes that make big differences, and being unafraid to promote and share them.Even solutions that are 'engineered' to change Taking ownership of change means being complex systems (e.g. electronic prescribing) may be bedevilled by human behaviour and workplace culture.unafraid to comment on imported solutions, seeking opportunities to influence developers, and proactively tailoring solutions to local circumstancesElements of a safe prescribing climate Education, training and feedbackIn published research prescribing education has taken the form of e-learning, tutorials, courses and posters;8 in clinical practice, it typically involves pharmacist-led presentations during junior doctor inductions and, sometimes, written tests of competency 9. While these approaches may provide an important foundation (e.g.…”

Paediatric Patient Safety and the Need for Aviation Black Box Thinking to Learn From and Prevent Medication Errors

“…It is reassuring to see growing evidence to improve medication safety in children through identifying areas where errors occur in order to target resources and interventions, through improving education provided in relation to pediatric prescribing [14] and having pharmacists present to make interventions [10]. The research that has been done has not specifically focused on strategies to reduce errors that have the potential to cause serious harm, which may be a reason behind why harmful errors continue to occur.…”