Abstract
Medication errors are commonly reported in the pediatric population. While evidence supports the use of e-prescribing to prevent certain errors, prescribing with an electronic health record (EHR) system is not devoid of errors. Furthermore, the majority of EHRs are not equipped with functionalities addressing pediatric needs. This study analyzes three unique EHRs in three pediatric clinics. It describes the functionality of each system and identifies errors found in e-prescribed prescriptions. Finally, the study estimates the proportion of e-prescribing errors that could have been avoided if those EHRs had met requirements set by the American Academy of Pediatrics (AAP). The number of prescriptions reviewed for Clinics 1, 2, and 3, respectively, were: 477, 408, and 633 with total error rates of 13.2%, 8.8%, and 6.6%. The clinic EHRs included 21%, 26%, and 47% of the AAP pediatric requirements for safe and effective e-prescribing for children. If all AAP elements had been included in the EHRs, over 83% of errors in the examined e-prescriptions could have been prevented. This study demonstrates that EHR systems used by many pediatric clinic practices do not meet the standard set forth by the AAP. To ensure our most vulnerable population is better protected, it is imperative that medical technology tools adequately consider pediatric needs during development and that this is reflected in selected EHR systems.
Highlights
The Joint Commission (Oakbrook Terrace, IL, USA) reports that errors linked to medications are believed to be the most common medical related errors [1]
To ensure our most vulnerable population is better protected, it is imperative that medical technology tools adequately consider pediatric needs during development and that this is reflected in selected electronic health record (EHR) systems
Using the Academy of Pediatrics (AAP) policy as a guide, this study evaluated real-life pediatric medication errors against recommendations identified within the AAP policy
Summary
The Joint Commission (Oakbrook Terrace, IL, USA) reports that errors linked to medications are believed to be the most common medical related errors [1]. They account for a significant cause of preventable adverse events [1]. Common pediatric medication errors include improper dose or quantity, omission error, and wrong drug; all of which could be encountered with electronic prescribing (e-prescribing). There are often limited or no rules related to drug selection, standardization of weight/use of weight in the electronic health record (EHR), or dose formulation identification. A systematic review of information technology (IT) interventions revealed that only one-half of the randomized controlled trials studied demonstrated that e-prescribing resulted in a significant reduction of medication errors [4]
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