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Discrepancies between medication orders and infusion pump programming in a paediatric intensive care unit
Rebecca A Russell1, Kathy Murkowski, Matthew C Scanlon
1Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, PO Box 1997, MS 681, 9000 West Wisconsin Avenue, Milwaukee, WI 53201, USA. rarussel@mcw.edu
Quality & Safety in Health Care
|October 21, 2010
Summary
Medication errors in pediatric intensive care units are common. Discrepancies between computer order entry and smart pump settings occurred in over 24% of medication infusions and 42% of fluid infusions.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Patient safety research
Background:
- Medication errors pose significant risks to pediatric patients in hospitals.
- Technology adoption, including CPOE and smart pumps, is recommended to mitigate risks, but evidence is limited.
- Paediatric inpatients are particularly vulnerable to medication-related harm.
Purpose of the Study:
- To quantify discrepancies between medication orders entered via CPOE and actual infusion pump settings.
- To assess the accuracy of smart infusion pumps in paediatric intensive care settings.
- To identify specific medication classes with high rates of order-pump discrepancies.
Main Methods:
- Prospective, observational study design.
- Data collection in a 30-bed paediatric intensive care unit.
- Simultaneous observation of CPOE orders and smart pump settings by trained personnel.
Main Results:
- Discrepancies were found in 24.3% of medication infusions and 42.4% of fluid infusions.
- High discrepancy rates were noted for anti-infectives (100%), concentrated electrolytes (46.7%), and anticoagulants (46.2%).
- Line-by-line comparison revealed significant variations between ordered and programmed infusion parameters.
Conclusions:
- Significant discrepancies exist between electronic medication orders and smart pump programming in paediatric ICUs.
- These findings highlight potential safety gaps despite technology implementation.
- Targeted interventions are needed for high-risk medication classes to improve infusion accuracy.
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