Zero tolerance prescribing: a strategy to reduce prescribing errors on the paediatric intensive care unit

Area of Science:

• Pediatric Intensive Care
• Medication Safety
• Healthcare Quality Improvement

Background:

• Prescribing errors pose a significant risk in pediatric intensive care units (PICUs).
• Establishing baseline error rates is crucial for evaluating interventions.
• A zero tolerance prescribing (ZTP) policy aims to minimize medication errors.

Purpose of the Study:

• To determine the baseline prescribing error rate in a tertiary PICU.
• To assess the impact of a ZTP policy on prescribing errors.
• To evaluate the effect of daily error feedback on medication safety.

Main Methods:

• A prospective, non-blinded, observational study conducted over 134 weeks in a 12-bed tertiary PICU.
• Baseline error data collected for 32 weeks, followed by ZTP policy implementation.
• Errors were sub-classified into clinical, non-clinical, and infusion prescription types.

Main Results:

• Baseline prescribing error rate was 892 per 1,000 occupied bed days (OBDs).
• Combined ZTP and daily feedback reduced errors to 447 per 1,000 OBDs (44.5% reduction, p < 0.0001).
• ZTP decreased clinical and infusion errors; daily feedback reduced non-clinical errors.

Conclusions:

• Combined ZTP and daily feedback significantly reduced prescribing errors in the PICU.
• The interventions achieved a reduction aligned with Department of Health targets.
• This strategy enhances medication safety in critical pediatric care settings.