Interventions to Reduce Medication Errors in Pediatric Intensive Care

Abstract

Objective: To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units. Data Sources: Databases were searched from inception to April 2014. Study Selection and Data Extraction: Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors. Data Synthesis: In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ2(5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79); IS: 0.37 (95% CI = 0.19, 0.73); ME: 0.36 (95% CI = 0.22, 0.58); PG: 0.82 (95% CI = 0.21, 3.25); PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03). Conclusions: Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions.

The effectiveness of interventions designed to reduce medication administration errors: a synthesis of findings from systematic reviews

“…, Manias et al . ) used quantitative pooling methods and, therefore, results were presented in the narrative form.…”

“…, Manias et al . , Raban & Westbrook ) that examined the impact of the checklist, protocols and guidelines on medication administration processes. Checklists, in the form of simple paper reminders posted on medical charts or complex computerised reminders, are commonly used to prompt clinicians to remember to perform critical tasks.…”

Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review

“…Two previous systematic reviews investigated the impact of interventions to reduce medication errors in children, but did not discuss the fact that many of the studies included were of low quality . This systematic review critically described and assessed the quality of the published literature.…”

A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom

“…Weight‐based infusions have been shown to be prone to error, with 27% of infusion orders found to contain a prescribing error and 65% of prepared infusions being >10% variant from the prescribed concentration . By introducing SCI both of these error modes can be reduced by 50% or more …”

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