Prescription writing errors in the pediatric emergency department

To determine the frequency, type, and severity of written prescription (RX) errors in a pediatric emergency department with attention to specialty and level of training of the residents who wrote the RXs.

Copies of RXs written by residents in a pediatric emergency department during a 6-month period were matched with pediatric emergency department records. Investigators evaluated individual RXs. Errors were noted and grouped into categories. Severity of errors was scaled, based on predetermined criteria (from previously published articles). The prescribing physician's specialty and level of training were documented. Discharge instructions were reviewed to determine if RX errors were later clarified.

There were 358 RXs eligible for overall descriptive analysis. A total of 212 RXs (59%) contained 311 errors. Discharge instructions ameliorated 16% of the RXs containing an error. Minor omissions were the most common error (62%), followed by incomplete directions (23%), dose/directions errors (6%), and unclear quantity to dispense (5%). In analysis of resident specialty and level of training, 339 RXs, written by 47 residents, were included. RXs written by pediatric residents were less likely to have an error (48%) than those by emergency medicine (81%), family medicine (76%), or combined internal medicine/pediatrics residents (100%). First year residents' RXs were errant 59%, second year residents 42%, and third year residents 69% of the time. The majority of RXs with errors (77%) were categorized as insignificant. Nineteen percent of RXs were defined as a problem and were unlikely to be filled. Less than 5% of errors were significant, and none were serious or severe.

RX errors are very common in the pediatric emergency department. Pediatric-specific experience was more influential than level of training on reducing the likelihood of error.