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Risk Factors for Electronic Prescription Errors in Pediatric Intensive Care Patients
Gili Kadmon1, Michal Shifrin1, Michal Pinchover2
1Pediatric Intensive Care Unit, Sackler Faculty of Medicine, Schneider Children's Medical Center in Israel, Tel Aviv University, Petach Tikva, Israel.
Insights
Older patients and those with severe conditions are more prone to electronic prescription errors in pediatric intensive care units (PICUs). Understanding these risk factors is key to improving medication safety.
Area of Science:
- Pediatric intensive care
- Health informatics
- Medication safety
Background:
- Electronic prescribing systems aim to reduce medication errors.
- Clinical decision support systems (CDSS) are integrated into electronic prescribing.
- Identifying specific risk factors for errors in pediatric intensive care units (PICUs) is crucial.
Purpose of the Study:
- To identify risk factors associated with electronic prescription errors.
- To analyze prescription data from a computerized physician order entry (CPOE) system with CDSS in a PICU.
Main Methods:
- Retrospective analysis of 6,250 electronic prescriptions.
- Comparison of error rates across different age groups.
- Statistical analysis of patient characteristics, disease severity (Pediatric Index of Mortality 2), PICU length of stay, and admission diagnoses.
Main Results:
- An overall electronic prescription error rate of 1.6% (101 errors).
- Error rates were significantly higher in patients older than 12 years (2.4%) compared to younger children.
- Patients with errors had higher disease severity scores, longer PICU stays, more prescriptions, and were more likely to have neurologic diagnoses.
Conclusions:
- Older patient age is a significant risk factor for electronic prescription errors in the PICU.
- Increased disease severity, indicated by higher Pediatric Index of Mortality 2 scores, is also linked to higher error rates.
- These findings highlight the need for targeted interventions to mitigate prescription errors in vulnerable pediatric populations.
Objectives:
To assess risk factors for electronic prescription errors in a PICU.
Design:
A database of electronic prescriptions issued by a computerized physician order entry with clinical decision support system was analyzed to identify risk factors for prescription errors.
Measurements And Main Results:
Of 6,250 prescriptions, 101 were associated with errors (1.6%). The error rate was twice as high in patients older than 12 years than in patients children 6-12 and 0-6 years old (2.4% vs 1.3% and 1.2%, respectively, p < 0.05). Compared with patients without errors, patients with errors had a significantly higher score on the Pediatric Index of Mortality 2 (-3.7 vs -4.5; p = 0.05), longer PICU stay (6 vs 3.1 d; p < 0.0001), and higher number of prescriptions per patient (40.8 vs. 15.7; p < 0.0001). In addition, patients with errors were more likely to have a neurologic main admission diagnosis (p = 0.008) and less likely to have a cardiologic diagnosis (p = 0.03) than patients without errors.
Conclusions:
Our findings suggest that older patient age and greater disease severity are risk factors for electronic prescription errors.
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