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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
Insights
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.
Background:
Errors and the incorrect use of medications are significant sources of risk and harm to children in US hospitals. The risk associated with medication infusions has led to recommendations for the adoption of technologies including computer order physician entry (CPOE) and 'smart' infusion pumps despite a paucity of evidence demonstrating the ability of these technologies to reduce harm to paediatric inpatients.
Objective:
To measure discrepancies between medication orders for infusions entered into a CPOE system and the medication being infused as measured by the programmed settings of the smart infusion pump within a paediatric intensive care unit.
Methods:
This study used a prospective, observational design in a 30-bed paediatric intensive care unit. Data were simultaneously collected from the medication orders in the CPOE system and the bedside smart infusion pumps by trained observers. Analysis consisted of a line-by-line comparison of order observation data with the pump observation data.
Conclusions:
Of 296 observations of medication infusions and 231 observations of intravenous fluid infusions, the frequency of discrepancies between orders entered and pumps programming ranged from 24.3% for observed medications to 42.4% for observed fluids. Anti-infectives (100%), concentrated electrolytes (46.7%) and anticoagulants (46.2%) were associated with greatest discrepancy between orders and programmed doses.
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