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Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic
D F Bannan1,2, M P Tully1
1Manchester Pharmacy School, University of Manchester, Manchester, UK.
Insights
Bundle interventions aim to reduce medication errors in hospitalized children. However, studies evaluating these interventions are of low quality, hindering impact assessment.
Area of Science:
- Patient safety research
- Pediatric healthcare quality
- Medication error reduction strategies
Background:
- Bundle interventions are increasingly utilized for patient safety.
- Prescribing errors (PEs) and administration errors (AEs) are significant concerns in pediatric hospital care.
- Existing literature on bundle interventions for pediatric medication errors requires critical appraisal.
Purpose of the Study:
- To categorize bundle interventions used to decrease PEs and AEs in hospitalized children.
- To evaluate the methodological quality of studies reporting on these bundle interventions.
Main Methods:
- A systematic review of English and Arabic articles from 1985-2015 was conducted.
- Interventions within bundles were classified using the EPOC taxonomy and the Behavioural Change Wheel (BCW).
- Risk of bias was assessed independently by two authors.
Main Results:
- Seventeen studies met the inclusion criteria, all employing professional or organizational interventions.
- The most common intervention functions were environmental restructuring and education, with some bundles incorporating multiple functions.
- All included studies were of low quality, primarily 'before/after' designs, with significant risks of bias (e.g., detection, selection).
- Intervention descriptions were often inadequate.
Conclusions:
- Bundle interventions with multiple functions have been explored for pediatric medication error reduction.
- The overall low quality and high risk of bias in the reviewed studies preclude definitive conclusions about their impact.
- Further high-quality research is needed to ascertain the effectiveness of bundle interventions in improving pediatric patient safety.
What Is Known And Objective:
Bundle interventions are becoming increasingly used as patient safety interventions. The objective of this study was to describe and categorize which bundle interventions are used to reduce prescribing errors (PEs) and administration errors (AEs) in hospitalized children and to assess the quality of the published literature.
Methods:
Articles published in English and Arabic between 1985 and September 2015 were sought in MEDLINE, EMBASE and CINHAL. Bibliographies of included articles were screened for additional studies. We included any study with a comparator group reporting rates of PEs and AEs. Two authors independently extracted data, classified interventions in each bundle and assessed the studies for potential risk of bias. Constituent interventions of the bundles were categorized using both the Cochrane Effective Practice and Organization of Care Group (EPOC) taxonomy of intervention and the Behavioural Change Wheel (BCW).
Results And Discussion:
Seventeen studies met the inclusion criteria. All bundles contained interventions that were either professional, organizational or a mixture of both. According to the BCW, studies used interventions with functions delivering environmental restructuring (17/17), education (16/17), persuasion (4/17), training (3/17), restriction (3/17), incentivization (1/17), coercion (1/17), modelling (1/17) and enablement (1/17). Nine studies had bundles with two intervention functions, and eight studies had three or more intervention functions. All studies were low quality before/after studies. Selection bias varied between studies. Performance bias was either low or unclear. Attrition bias was unclear, and detection bias was rated high in most studies. Ten studies described the interventions fairly well, and seven studies did not adequately explain the interventions used.
What Is New And Conclusion:
This novel analysis in a systematic review showed that bundle interventions delivering two or more intervention functions have been investigated but that the study quality was too poor to assess impact.
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